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Percutaneous transhepatic cholangiography
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== Internal drainage == * Stents ** Plastic (polymer) *** Larger in calibre - 10F or 12F - theoretical risk of pain and bleeding *** Cheaper *** Majority are placed endoscopically ** Metal *** Better for palliation - larger diameter, lasts longer, cheaper *** Smaller in calibre at deployment - can use a 6F or 7F sheath system and expand to 1cm (SEMS) *** Reduce risk of pancreatitis by placing suprapapillary rather than transpapillary *** Generally lasts for 6-12 months without occluding *** Covered seem to last longer than uncovered **** Uncovered - tumour infiltration **** Covered - tumour overgrowth at edges, sludge formation, stent migration ** Expanded PTFE (ePTFE) stents *** In development, may improve long-term patency * Often, can remove the transhepatic access straight away, but consider leaving internal/external drain if risk of bleeding due to friable tumour - allow you to go back in 2 days, check for occluding thrombus, then remove access
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