J Korean Soc Radiol.  2011 Apr;64(4):317-323. 10.3348/jksr.2011.64.4.317.

Usefulness of a Biliary Manipulation Catheter in Percutaneous Transhepatic Biliary Drainage

• Park AW
• Won JH
• Lee JH
• Sun JS
• Kwak KS
• Bae JI

• KMID: 1443533
• DOI: http://doi.org/10.3348/jksr.2011.64.4.317

Abstract

PURPOSE
To evaluate usefulness of a manipulation catheter in percutaneous transhepatic biliary drainage (PTBD).
MATERIALS AND METHODS
A biliary manipulation catheter was used for the aspiration of retained bile and lesion crossing during an initial PTBD in 91 consecutive patients over a 6 month period. This catheter allowed for a 0.035 inch guide wire made of 5F short steel braided polyurethane. The terminal 1 cm segment was tapered and 45degrees angulated. Two side holes were made in the terminal segment to facilitate the aspiration of bile. The safety of this procedure was evaluated based on whether the catheters caused complications during insertion and manipulation, and whether cholangitis was aggravated after the procedure. Effectiveness of the procedure was evaluated based on the ability to aspirate retained bile and to cross the lesion.
RESULTS
Both the insertion of a 0.035 inch hydrophilic guide wire and aspiration of sufficient retained bile were successful with the catheter. Crossing the common bile duct (CBD) lesion had a 98.1% success rate during the initial PTBD. Crossing the hilar obstruction lesion was had a 94.7% success rate to the CBD and 92.1% to the contralateral lobe. Cholangitis improved in 97% of cases, and aggravated transiently in only 3% of cases after PTBD.
CONCLUSION
A biliary manipulation catheter should be considered as a useful tool for a safe and effective PTBD, attributed to the facilitation of bile aspiration and lesion crossing.

MeSH Terms

Bile
Bile Ducts
Catheters
Cholangitis
Common Bile Duct
Dioxolanes
Drainage
Fluorocarbons
Humans
Polyurethanes
Radiography, Interventional
Steel
Dioxolanes
Fluorocarbons
Polyurethanes
Steel

Figure

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  Fig. 1 A. The manipulation catheter was 40 cm in length with a stiff braided shaft. B. The terminal 1 cm segment was tapered and 45° angulated. Two side holes made in the terminal segment can facilitate aspiration of bile during the manipulation

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  Fig. 2 Malignant biliary hilar obstruction in a 65-old-male patient. A. A manipulation catheter was inserted through a right bile duct access. Retained bile was successfully aspirated. B. A cholangiogram with the manipulation catheter demonstrated hilar lesion extension. C. Crossing the lesion to the left duct was successful with the help of the manipulation catheter. Bilobar external drainage was performed.

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