A percutaneous transhepatic cholangiogram (PTC) is performed in cases of biliary obstruction when ERCP is not possible (previous Bilroth II gastrectomy, choledochojejunostomy) or if ERCP has failed. A fine needle (22 guage) is used to puncture the biliary tree and inject radiographic contrast in order to demonstrate the anatomy of the dilated bile ducts. This initial puncture can be performed under fluoroscopy or using ultrasound guidance (when a specific duct is targeted). From the cholangiogram, it is usually possible to confirm the cause of bile duct obstruction. Common causes included gallstones, cholangio carcinoma, pancreatic carcinoma, extrinsic compression from liver metastases or benign strictures, e.g. after bile duct surgery. Metallic stents are inserted only for malignant bile duct strictures/obstruction.
In order to deploy a metal stent, it is necessary to position a guide wire across the bile duct stricture and into the duodenum. This is sometimes done using the initial access for the PTC or it may be performed by repuncturing the biliary tree at a more suitable site. Once a guide wire is in the duodenum, the stricture can be dilated with a balloon catheter (especially if very tight), prior to deploying the stent. The stent delivery system is passed over the previously sited guide wire and deployed with its tip just into the duodenum. If a catheter is inserted along the guide wire, a check cholangiogram can be performed to confirm patency and position (see Fig. 6.20). The advantage of internal biliary drainage is that it avoids the electrolyte and fluid losses, and risk of sepsis associated with external drainage.
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One of the main home remedies that you need to follow to prevent gallstones is a healthy lifestyle. You need to maintain a healthy body weight to prevent gallstones. The following are the best home remedies that will help you to treat and prevent gallstones.