Experience with percutaneous transhepatic cholangiography using the Japanese needle

Abstract

Abstract. Percutaneous transhepatic cholangiography using a very thin needle has been performed in 885 patients with a variety of underlying hepatic, biliary, and pancreatic disorders. The procedure was successful in 99% of the patients with dilated intrahepatic bile ducts and in 85% of those with non-dilated ducts. Complications which required surgical intervention occurred only in two cases (0.2%). In patients with obstructive jaundice, external bile drainage was performed immediately after visualization of the bile duct. Percutaneous transhepatic cholangiography is an extremely useful and safe method for investigating disorders of the biliary tract, for localizing the cause of obstructive jaundice, and for reducing the degree of jaundice and improving the general status of patients with obstructive jaundice.

Cholangiographic demonstration of postoperative bile leakage from aberrant biliary ducts

“…PTC has been used extensively in the diagnosis and evaluation of extrahepatic jaundice [7,[10][11][12]. Success rates of penetrating and opacifying normal caliber ducts vary from 50 to 90% [11].…”

“…The incidence of complications is extremely low; the highest reported incidence of intraperitoneal bleeding was 2-3%, although in 2 series totaling over 1000 cases this complication was not encountered [11]. Biliary leakage can occur, the highest incidence being 1.7-2.2% [10,11]. Sepsis with hypotension, the most worrying complication, usually occurs when an obstructed biliary system is overdistended [11,12].…”

“…The low incidence of complication and the strong likelihood of opacifying normal caliber ducts renders PTC a safe and reliable technique for imaging the biliary system [10,12]. Its superiority over other imaging modalities in the demonstration of biliary anatomy is beyond question, and therefore PTC should be the method of choice in attempting to demonstrate the source of biliary leakage.…”

Percutaneous transhepatic insertion of a permanent endoprosthesis in obstructive lesions of the extrahepatic bile ducts

“…It appears from the experience of the present authors and that of Burcharth and coworkers [26,27] that side holes in both the proximal and distal parts of the endoprosthesis seem to be essential for sufficient drainage function. Furthermore, there is no reason to believe that finer catheters and endoprostheses which have been applied to drain bile externally [13,15], combined internally/externally [16][17][18][19][20][21][22]24], and internally [26,27] are less traumatic ttian largebore tubes. The formation of intrahepatic aneurysms following bile duct intubation with a percutaneous transhepatic catheter (OD 2.2 ram) has been described [13,19].…”

“…Further technical refinement has made it possible to manipulate percutaneous transhepatic catheters through the obstructing lesion into the distal segment of the common bile duct or the duodenum. This facilitates combined external/internal bile drainage [16][17][18][19][20][21][22][23][24]. The subsequent creation of a nonsurgical biliodigestive communication by percutaneous transhepatic insertion of a bile duct endoprosthesis through the malignant stricture of the extrahepatic bile ducts has also been reported [25][26][27][28].…”