ERCP (transduodenoscopy) route and PTCD route for obstructive jaundice FAQ 1. ERCP route for obstructive jaundice is routinely performed (surgical procedure) ERCP is performed through a duodenoscope, a duodenoscope such as a fiber hose, which is delivered through the mouth into the stomach and duodenum after local surface anesthesia. During the operation, the patient deals with the awake state and there are some uncomfortable reactions such as nausea and vomiting during the delivery of the mirror. After the duodenoscope reaches the duodenum, the location of the duodenal papilla, which is the final exit of the bile duct from the intestinal canal, is sought. The biliary tract can be observed and the site of obstruction can be determined by general retrograde intubation through the papilla. For manageable obstruction, a guidewire must be placed through the stricture first, which is a key step. After the passage of the guidewire, operations such as stent placement can be performed to assist biliary drainage. 2, PTCD route for the treatment of obstructive jaundice conventional method (surgical procedure) The surgical access for PTCD is the left quarter rib, and the puncture needle passes through the skin and a small amount of liver parenchyma directly to the intrahepatic bile duct (different from ERCP which first proceeds to the end of the bile duct, i.e. retrograde operation), it is a prograde operation. After the needle is in place, a guide wire is introduced into the sheath, and the entire biliary system is visualized with contrast to find the site and cause of obstruction. For the obstruction, the guidewire is passed first, followed by local dilation, and finally a drainage tube or stent is placed to relieve the obstruction and achieve smooth drainage of bile to the duodenum to relieve obstructive jaundice. 3.What are the main advantages of the ERCP route for the treatment of obstructive jaundice compared to PTCD? I. ERCP is performed through the natural lumen of the body (oral cavity and gastrointestinal tract), which avoids some invasive procedures and can reduce complications such as bleeding compared to PTCD; II. ERCP can achieve indirect observation of the duodenal papilla and allow histological examination (biopsy) during the operation, which has a confirmatory value for partial obstructive jaundice caused by terminal obstruction of the common bile duct; however, for non- lesions near the duodenal papilla, again, a definitive diagnosis cannot be made; iii. For obstructive jaundice due to choledochal stones, ERCP can be performed via the duodenal papilla to remove the cause of the disease while reducing the yellowing; iv. Theoretically, bilateral, multi-branch biliary drainage of the bile duct can be performed via the ERCP route without significantly increasing trauma. For multiple bile duct obstructions on the left or right side caused by, for example, hilar bile duct stenosis (tumor or non-tumor), multiple obstructed bile ducts can be drained in one or via multiple treatments to achieve better and faster reduction of bilirubin levels. However, this operation requires a high level of operator skill, and the success rate varies from person to person. 4.What are the main advantages of PTCD over ERCP for the treatment of obstructive jaundice? I. PTCD directly punctures the intrahepatic bile duct via the right quarter intercostal tissue and a small portion of the liver parenchyma, which significantly shortens the operative path compared to ERCP (the operative path of PTCD is only 20 to 30 cm, whereas the common endoscopic length of ERCP is more than 100 cm), which greatly reduces the difficulty of the operation and increases its success rate; II. For obstructive jaundice caused by tougher obstructions (such as bile duct cancer) (b) For obstructive jaundice caused by tougher obstructions (e.g. bile duct cancer), thanks to the short operation path and smooth angle, PTCD has a much better ability to pass the obstructed segment than the ERCP route, and the treatment success rate for this part of patients is much higher than that of ERCP; (c) In the diagnosis of biliary system diseases, thanks to the short path and imaging equipment that is significantly better than ERCP, the PTCD route has excellent imaging quality and accurate localization ability in the diagnosis. Accurate diagnosis is the ultimate guarantee of treatment; iv. PTCD is not affected by bile duct surgery (such as bile-intestinal anastomosis, etc.), whereas in this part of patients, ERCP treatment will be very difficult due to changes in the relative relationship between the intestine and the bile duct; in this part of patients with biliary obstruction, PTCD may be the only option; v. Thanks to the short route and convenient access, as well as the abundant interventional devices, the The PTCD route is rich in treatment tools, such as balloon dilation, complex stent placement (e.g. Y-shaped), lithotripsy, biopsy, etc.; 6. For stent placement, thanks to excellent imaging guidance, the PTCD route has more accurate positioning than the ERCP route, thus ensuring the effect of yellowing reduction after stent placement; moreover, for complex lesions, the PTCD route can perform stent placement in complex shapes (e.g., Y-shaped bilateral drainage via unilateral access); viii. The ERCP route often requires operations such as incision of the duodenal papilla, which can cause permanent damage to its sphincter function; the PTCD route does not require invasive operations on the duodenal papilla and will not adversely affect its function; for general drainage, using new special techniques, the drainage tube can be left at the end of the common bile duct without passing through the duodenal papilla (such as the Y-shaped drainage tube placement technique in our department), which can basically eliminate the need for the drainage tube. (such as the Y-shaped drainage tube placement technique in our department), which can basically eliminate the occurrence of bile reflux. Nine, for the common biliary drains, the PTCD route has a very rich product line to choose from, with various calibers of drains, and the flexibility and patency rate of drains are much better than that of the ERCP route, which is commonly used for internal drains (stent tubes).