CPT® Code 74363

1. Indications

The procedure of percutaneous transhepatic dilation of biliary duct stricture is indicated for various conditions that lead to the narrowing of the bile ducts. These indications include:

• Biliary Obstruction - This may occur due to tumors, strictures, or other pathological conditions that impede the normal flow of bile.
• Cholestasis - A condition characterized by the reduction or stoppage of bile flow, often resulting from strictures.
• Post-Surgical Complications - Strictures may develop following surgical procedures involving the biliary system, necessitating intervention.
• Benign Biliary Strictures - Non-cancerous strictures that can arise from various causes, including inflammation or previous surgeries.

2. Procedure

The procedure involves several critical steps to ensure effective dilation of the biliary duct stricture:

• Step 1: Accessing the Biliary Duct - The procedure begins with the insertion of a flexible fiberoptic endoscope through a T-tube or other access tract. This allows the physician to visualize the biliary system and identify the location of the stricture.
• Step 2: Inspection of the Bile Ducts - Once the endoscope is in place, the physician inspects the bile ducts for any signs of disease or abnormalities that may contribute to the stricture.
• Step 3: Balloon Catheter Placement - A balloon catheter is then introduced through a separate channel in the endoscope. The balloon is carefully positioned within the narrowed segment of the duct.
• Step 4: Balloon Inflation - The balloon is inflated within the stricture for a short period, which helps to widen the narrowed area. This inflation may be repeated multiple times to achieve the desired dilation effect.
• Step 5: Re-evaluation of the Stricture - After each inflation, the balloon is deflated, and the stricture is re-evaluated to assess the effectiveness of the dilation.
• Step 6: Stent Placement (if necessary) - If a stent is indicated, it is advanced through the endoscope to the site of the stricture in its collapsed form. Once properly positioned, the stent is deployed to maintain the duct's patency.
• Step 7: Final Inspection - As the endoscope is withdrawn, the physician inspects the bile ducts again for any signs of injury or additional disease, ensuring that the procedure has not caused any complications.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any immediate complications that may arise from the dilation or stent placement. Patients may be observed for signs of infection, bleeding, or any adverse reactions. Follow-up imaging may be required to assess the effectiveness of the dilation and the status of the bile ducts. Additionally, the physician may provide specific instructions regarding activity levels, dietary modifications, and any necessary follow-up appointments to ensure proper recovery and management of the biliary system.