| Cholangiography is a procedure that allows visualization of the ducts (common bile duct and cystic duct) that carry bile from the liver and gallbladder into the small intestine. Following injection of a radiopaque dye (iodipamide meglumine) into the ducts, x-ray pictures (cholangiograms) are taken of the abdominal area in which the ducts are located. The absence of dye in a section of the bile ducts provides evidence that the duct is obstructed.
There are four types of cholangiography: postoperative cholangiography, endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC), and magnetic resonance cholangiopancreatography (MRCP). They differ in how the dye is injected into the ductile system.
Postoperative cholangiography is done by injecting the dye into a T-shaped rubber tube that is inserted into the common bile duct during surgery to remove the gallbladder (cholecystectomy) or to perform common bile duct exploration. Endoscopic retrograde cholangiopancreatography involves passage of a flexible fiberoptic microscope (endoscope) through the mouth into the small intestine (duodenum). A tube (catheter) is then passed into the common bile duct (and possibly the pancreatic duct), and radiopaque dye is injected. ERCP is the preferred invasive imaging modality because of its relatively low rate of serious morbidity (3% to 5%) and its ability to image and treat diseases of the bile duct, ampulla, pancreas, and duodenum. Percutaneous transhepatic cholangiography (PTC) involves injecting dye through the abdominal skin into the ductile system in the liver using a long, slender needle. Magnetic resonance cholangiopancreatography (MRCP) is becoming the preferred imaging technique; it is the best and most sensitive noninvasive test for biliary obstruction. On some occasions, the individual can be taken directly for surgical therapy after MRCP. Use of MRCP as the sole pre-operative examination will increase the availability of this test, which is currently limited to the larger medical centers.
Bile duct obstruction is usually caused by stones (calculi) that have formed in the gallbladder and passed into the common bile duct. Other, less common causes of bile duct obstruction may include abnormal tissue growth (malignant tumor) or harmless (benign) strictures within the duct. The presence of calculi in the bile ducts is referred to as choledocholithiasis. |
Source: Medical Disability Advisor
| Cholangiography is a procedure that allows the bile ducts to be visualized in order to determine if they have narrowed or become blocked. This procedure may be performed on individuals who have abdominal pain, yellow-tinted skin (jaundice) and fever or chills (Charcot's triad), or liver and spleen enlargement. All these symptoms suggest obstruction and inflammation of the bile ducts (cholangitis). Cholangiography may also be performed on individuals suspected of having a tumor that is blocking the bile ducts or individuals who have an abnormal stricture of the ducts that is causing blockage. Symptoms of these conditions may include those seen with cholangitis. |
Source: Medical Disability Advisor
| Postoperative cholangiography is performed after surgery to remove the gallbladder (cholecystectomy) or to perform common bile duct exploration. During surgery, a T-shaped rubber tube is inserted into the common bile duct to facilitate drainage. Seven to ten days later, cholangiography is performed. Food and drink are withheld, and an enema may be administered about 1 hour prior to the test.
The individual lies on his or her back (supine position) on a flat, hard (radiographic) table. The T-tube is cleaned, approximately 5 ml of radiopaque contrast medium is injected into the T-tube, and x-ray images are taken. Additional contrast medium is usually injected (20 to 25 ml), and other x-rays are then taken as the individual is moved through a variety of positions on the table. The individual is then helped to a standing position for additional x-rays. The entire procedure, to this point, takes about 15 minutes. A final x-ray is taken 15 minutes after the final injection of contrast medium to record the emptying of contrast-laden bile into the small intestine (duodenum). Postoperative cholangiography is not painful, although the individual may feel a bloating sensation in the upper right part of the abdomen (upper right quadrant) as the contrast medium is injected.
Endoscopic retrograde cholangiopancreatography (ERCP) is performed by injecting radiopaque contrast medium directly into the bile ducts and pancreatic duct through a flexible tube (endoscope) that is inserted through the mouth and down into the digestive system. The individual is instructed to fast beginning at midnight on the day of the procedure. Just prior to the procedure, an intravenous (IV) line is inserted into a blood vessel in order to administer drugs and fluids. A sedative is given via the IV line, and the individual is relaxed but conscious. Also, a local anesthetic is sprayed on the back of the throat to calm the gag reflex. The spray will have an unpleasant taste, and it will make the tongue and throat feel swollen and may cause some difficulty swallowing. A mouth guard, which does not obstruct breathing, may be inserted to protect the individual's teeth from the endoscope. The individual lies on the left side (left lateral position) as the endoscope is threaded into the mouth, throat, stomach, and small intestine (duodenum). The individual is then assisted into a position lying flat on the stomach (prone position). A small tube (cannula) is inserted through the endoscope and into the bile and pancreatic ducts. A small amount (2 to 5 ml) of contrast medium is injected through the cannula to allow visualization of the pancreas by x-ray. The cannula is then repositioned, and an additional 10 to 15 ml of contrast medium is injected to allow x-ray visualization of the bile ducts. The individual is asked to remain in the prone position while the x-ray films are developed and reviewed. If necessary, additional films may be taken. If not, the cannula and endoscope is removed, and the procedure is complete. Normally, ERCP takes 30 to 60 minutes. Food and fluids are withheld until the throat anesthetic wears off and the gag reflex returns. Recovery time is generally 4 to 8 hours.
Percutaneous transhepatic cholangiography (PTC) is performed by injecting radiopaque contrast medium directly into the bile ductile system in the liver. The individual is instructed to fast for 8 hours before the test. Individuals are secured on their back (supine position) onto a flat, hard table (tilting x-ray table) that rotates into vertical and horizontal positions during the procedure. A sedative may be administered before the procedure begins. The upper right part of the abdomen (upper right quadrant) is cleansed, covered with a drape, and injected with a local anesthetic. The individual is asked to hold his or her breath at the end of expiration while a long, thin needle is inserted through the abdominal wall and into the liver. The needle is slowly withdrawn as contrast medium is injected. X-ray films are taken with the individual in different positions (supine and lateral recumbent positions). After the necessary x-rays have been taken, the needle is removed, and a sterile dressing is applied to the puncture site. The entire procedure takes approximately 30 minutes, but the individual should rest for at least 6 hours after the procedure is completed. |
Source: Medical Disability Advisor
| With cholangiography, the bile ducts are visible on x-ray film. ERCP will show the pancreatic ducts as well. Obstruction within the bile duct system is identified by the lack of radiopaque contrast medium in a segment of the duct. Also, if there is obstruction, the bile ducts usually appear to have a larger diameter (dilated) than normal. Nonobstructed ducts are of normal size. |
Source: Medical Disability Advisor
| Complications of any type of cholangiography may include an allergic reaction to the radiopaque contrast medium, nausea, vomiting, excessive salivation, flushing, skin eruptions (urticaria), and excessive sweating (diaphoresis). Additional complications of PTC may include increased heart rate (tachycardia), peritonitis, chills and fever; abdominal pain, abdominal tenderness and distention, and infection of the abdominal cavity. Additional complications of ERCP may include slowed breathing rate (respiratory depression), cessation of breathing (apnea), low blood pressure (hypotension), low heart rate (bradycardia), throat spasm (laryngospasm), puncture (perforation) of the gut, inflammation of the bile ducts (cholangitis), and inflammation of the pancreas (pancreatitis). |
Source: Medical Disability Advisor
| A full day is required to complete the test and allow for recovery. Following recovery, there should not be any limitations at work following cholangiography unless unforeseen complications such as an allergic reaction occur during the test. In this case, additional recovery time at home may be required. |
Source: Medical Disability Advisor
| Cabaltica, Rex B. G. Illustrated Guide to Diagnostic Tests. Springhouse, PA: Springhouse Corporation, 1994.Isaacs, K. L., and S. L. Levinson. "Percutaneous Transhepatic Cholangiography." Manual of Gastroenterologic Procedures. Ed. D. A. Drossman. New York: Raven Press, 1993. 116-122. |
Source: Medical Disability Advisor
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