Korean J Radiol.  2009 Apr;10(2):144-149. 10.3348/kjr.2009.10.2.144.

Clinical Feasibility and Usefulness of CT Fluoroscopy-Guided Percutaneous Transhepatic Biliary Drainage in Emergency Patients with Acute Obstructive Cholangitis

• Kim JH

• KMID: 1088725
• DOI: http://doi.org/10.3348/kjr.2009.10.2.144

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.

Keyword

Bile ducts, percutaneous drainage; Computed tomography (CT); Fluoroscopy; Computed tomography (CT) fluoroscopy

MeSH Terms

Acute Disease
Aged
Aged, 80 and over
Cholangiography
Cholangitis/*therapy
Drainage/*methods
Emergencies
Feasibility Studies
Female
*Fluoroscopy
Humans
Jaundice, Obstructive/*therapy
Male
Middle Aged
Prospective Studies
Radiography, Interventional
*Tomography, X-Ray Computed

Figure

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  Fig. 1 65-year-old male patient with distal CBD cancer.

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  Fig. 2 72-year-old patient with CBD cancer.

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