Percutaneous Cholecystocholangiogram in the Evaluation of Biliary Atresia

Review the clinical utility, technical considerations, and normal and abnormal findings of percutaneous transhepatic cholecystocholangiogram in the evaluation for biliary atresia.

Background:

Morbidity and mortality in infants with biliary atresia (BA) are greatly impacted by timely diagnosis and treatment. Diagnostic evaluation of neonatal cholestasis includes laboratory tests, non-invasive imaging with nuclear medicine and ultrasound, and percutaneous liver biopsy, although diagnostic errors may occur particularly early in the course of the disease. The gold standard has been intra-operative cholangiogram for the diagnosis of biliary atresia. Percutaneous transhepatic cholecystocholangiogram (PCC) may be performed by pediatric interventional radiology if the gallbladder is visualized at the time of percutaneous liver biopsy in the evaluation of biliary atresia. PCC has been shown to decrease the negative laparotomy rate by up to 47%.

Clinical Findings/Procedure Details:

Using ultrasound guidance, a small 21-25G needle is advanced into the gallbladder via a transhepatic approach. Contrast is injected under fluoroscopic guidance to opacify the biliary tree. Examples of normal and abnormal PCC studies are presented. A normal PCC fully opacifies the gallbladder, cystic duct, intra- and extra-hepatic biliary tree and duodenum. An abnormal PCC is compatible with biliary atresia if the biliary tree is diminutive, tortuous, and incompletely opacified.

Conclusion and/or Teaching Points:

Percutaneous cholecystocholangiogram is a minimally invasive diagnostic procedure that can be performed by pediatric interventional radiology at the time of percutaneous liver biopsy in the evaluation of biliary atresia.