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CASE REPORT article

Front. Oncol.

Sec. Gastrointestinal Cancers: Hepato Pancreatic Biliary Cancers

Volume 15 - 2025 | doi: 10.3389/fonc.2025.1620937

This article is part of the Research TopicIntrahepatic Cholangiocarcinoma: Emerging Insights from Pathobiology to Clinical Translation – Innovative Strategies, Challenges, and OpportunitiesView all 8 articles

Case Report: First case of percutaneous transhepatic cholangioscopy guided triple bridge drainage between multiple bile ducts for malignant hilar biliary obstruction

Provisionally accepted
Gang  TangGang Tang1Jie  ZhangJie Zhang1Rui  ChenRui Chen1Jingyi  ZhangJingyi Zhang2Rongxing  ZhouRongxing Zhou1*
  • 1Division of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China, Chengdu, China
  • 2Department of Medical Ultrasound, West China Hospital, Sichuan University, chengdu, China

The final, formatted version of the article will be published soon.

Background: Biliary drainage for advanced malignant hilar biliary obstruction (MHBO) remains a significant challenge in current clinical practice. Case description: A 58-year-old male diagnosed with unresectable advanced intrahepatic cholangiocarcinoma with hilar obstruction and required palliative biliary drainage. Imaging revealed obstruction of the common bile duct, left hepatic duct, right anterior hepatic duct, and right posterior hepatic duct (Bismuth–Corlette type IV). Due to the failure of ERCP, we decided to bridge biliary drainage with percutaneous transhepatic cholangioscopy (PTCS) after multidisciplinary discussion. This is a provisional file, not the final typeset article First, one-step PTCS was used to establish a channel between the skin and the right anterior hepatic duct. Then a puncture needle was used to puncture the right anterior hepatic duct to the distal common bile duct, and the first stent was inserted for bridging. Next, a puncture needle was used from the right anterior hepatic duct to the left hepatic duct and a second stent was inserted for bridging. Finally, a puncture needle was used to puncture the right anterior hepatic duct to the right posterior hepatic duct, and a third stent was inserted for bridging. Intraoperative X-ray examination with contrast agent injected through the sinus confirmed successful bridging. The jaundice disappeared a few days after surgery, and no post-procedure-related adverse events occurred. Conclusion: This case demonstrates that ultrasound-guided PTCS triple-bridge biliary drainage connecting multiple bile ducts is a feasible palliative option for MHBO and warrants further clinical investigation.

Keywords: Malignant hilar biliary obstruction, Percutaneous transhepaticcholangioscopy, Bridging technique, Biliary drainage, case report

Received: 30 Apr 2025; Accepted: 22 Sep 2025.

Copyright: © 2025 Tang, Zhang, Chen, Zhang and Zhou. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Rongxing Zhou, rongxingzhou@126.com

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