ABSTRACT
OBJECTIVE: To evaluate the feasibility of CT fluoroscopy (CTF)-guided percutaneous transhepatic biliary drainage (PTBD) in emergency patients with acute obstructive cholangitis. MATERIALS AND METHODS: The study included 28 patients admitted to the emergency center due to obstructive jaundice and found to require urgent biliary drainage, as well as judged to have a suitable peripheral bile duct for a CTF-guided puncture (at least 4 mm in width). Prior to the CTF-guided puncture, a CT scan was performed to evaluate bile duct dilatation and the underlying causes of biliary obstruction. If the patient was judged to be a suitable candidate, a CTF-guided PTBD was performed in the same CT unit without additional fluoroscopic guidance. Technical feasibility of the procedure was investigated with the evaluation of overall success rate and causes of failure. RESULTS: A hepatic puncture was attempted at the left lobe in 23 patients and right lobe in five patients. The procedure was successful in 24 of 28 patients (86%) Successful biliary puncture was achieved on the first attempt in 16 patients, the second attempt in five patients, and the third attempt in three patients. The causes of failure included guide wire twisting in one patient, biliary puncture failure in two patients, and poor visualization of the guide wire in one patient. There were no significant procedure-related complication. CONCLUSION: The CTF-guided PTBD is technically feasible and highly successful in patients judged to have a suitable indication. Moreover, although the procedure is unfamiliar and inconvenient to interventionalists, it has economical advantages in that it saves time and manpower. We believe this method can be used in the emergency patients requiring urgent biliary drainage as an alternative for the fluoroscopy-guided PTBD.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Acute Disease , Cholangiography , Cholangitis/therapy , Drainage/methods , Emergencies , Feasibility Studies , Fluoroscopy , Jaundice, Obstructive/therapy , Prospective Studies , Radiography, Interventional , Tomography, X-Ray ComputedABSTRACT
PURPOSE: To compare the feasibility and safety of US-guided right and left percutaneous transhepatic biliary drainage (PTBD). MATERIALS AND METHODS: Between March 1998 and May 1999, 32 patients underwent 36 US-guided right or left PTBD in referred order, alternatively. The causes of biliary obstruction were bile duct stone (n=2), bile duct carcinoma (n=10), carcinoma of the pancreas (n=9), GB carcinoma (n=7), metastasis to the porta hepatis (n=3), and carcinoma of the ampulla of vater (n=1). Technical success, procedure time, fluoroscopic time, and complications were evaluated. RESULTS: PTBD was successful in 94% of both right and left approach. The average procedure time was 9.7+/-3.8 min. in the right approach and 9.6+/-3.1 min. in the left approach, respectively (p=0.794). The average fluoroscopic time were 3.9+/-2.4 min. in the right approach and 3.8+/-2.2 min. in the left approach (p=0.892). A major complication, bile peritonitis, occurred in one of 16 patient with right-sided approach. Minor complications occurred in six right (2 hemobilia, 3 tube malfunction, 1 cholangitis) and three left (1 hemobilia, 1 fever, 1 cholangitis) PTBD. There were no significant difference in the complication rates between right and left PTBD (p=0.729). CONCLUSION: There were no significant differences in feasibility and safety in US-guided right and left PTBD.
Subject(s)
Humans , Ampulla of Vater , Bile , Bile Ducts , Drainage , Fever , Hemobilia , Neoplasm Metastasis , Pancreas , PeritonitisABSTRACT
The antegrade puncture technique represents a new approach to percutaneous transhepatic cholangiography andbiliary drainage. With this technique, ductal puncture begins with the liver capsule toward the hepaticparenchyma. This report briefly describes this new technique, and its safety and feasibility.
Subject(s)
Cholangiography , Drainage , Liver , PuncturesABSTRACT
PURPOSE: To evaluate the usefulness of percutaneous transhepatic biliary drainage (PTBD) tract dilatation using a Nipro set. MATERIALS AND METHODS: We dilated 28 percutaneous biliary drainage tracts up to 18F ; 26 procedures involved PTBD, and two, cholecystostomy. A Nipro set was used for dilatation, the purposes of which were stone removal (n=18) and choledochoscopic biposy (n=10). For dilatation, local anesthesia was used in all cases. RESULTS: In all patients, tract dilatation was successful. In 21 of 28 cases, dilatation of the right PTBD tract was involved, and in five of 28, dilatation of the left tract. In two cases, tract dilatation was done in cholecystostomy tracts. Complications encountered were pain (n=17), bradycardia (n=2), hemobilia (n=2), bleeding (n=1)and fever (n=1). CONCLUSION: In choledocoscopy, tract dilatation using a Nipro set is safe and simple.