Percutaneous Transhepatic Cholecysto-Cholangiography: Feasibility, Safety, and Diagnostic Accuracy in Cholestatic Jaundice - A Prospective Study.

Introduction: Biliary atresia (BA) is a major cause of neonatal cholestasis and the leading indication for pediatric liver transplantation. Timely and accurate diagnosis is critical to enable early surgical intervention and improve native liver survival. Percutaneous transhepatic cholecysto-cholangiography (PTCC) has emerged as a minimally invasive alternative to intraoperative cholangiography (IOC) for diagnosing BA. This prospective study aimed to evaluate the feasibility, safety, and diagnostic accuracy of PTCC in differentiating BA from other causes of neonatal cholestasis. Materials and Methods: Conducted between October 2023 and March 2025, this study enrolled infants under 6 months of age with clinical suspicion of BA. All patients underwent ultrasonography and PTCC. PTCC feasibility, diagnostic accuracy, and safety were assessed in comparison with IOC. Gallbladder (GB) parameters and laboratory findings were also analyzed. Results: Of the 45 enrolled patients, PTCC was feasible in 62.2% (28/45), diagnosing BA in 71.4% (20/28) and excluding it in 28.6% (8/28). PTCC was not feasible in 37.8% (17/45). Overall, BA was confirmed in 77.8% (35/45). Gallbladder parameters were evaluated as predictors of PTCC feasibility. Receiver operating characteristic analysis identified fasting GB volume, length, and width as significant predictors (P < 0.05) for PTCC feasibility (area under the curve 0.789, 0.716, 0.727, respectively). GB width demonstrated the highest sensitivity (82.1%) for predicting PTCC feasibility. No procedural complications were observed. Conclusion: PTCC is a safe, feasible, and reliable diagnostic modality for preoperative assessment of BA. GB parameters on ultrasound are significant predictors of PTCC feasibility, reinforcing its integration into the diagnostic workup for neonatal cholestasis.