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Medline ® Abstract for Reference 4

of 'Diagnostic approach to the adult with jaundice or asymptomatic hyperbilirubinemia'

Transhepatic cholangiography in patients with suspected biliary disease and nondilated intrahepatic bile ducts.
Teplick SK, Flick P, Brandon JC
Gastrointest Radiol. 1991;16(3):193.
Transhepatic cholangiography (THC) was performed in 107 patients who had nondilated intrahepatic bile ducts on computed tomography (CT) or ultrasound. The cholangiogram was diagnostic in 72 patients (67%). Thirty-one (43%) of the 72 diagnostic studies were abnormal and showed poor emptying, stones, or strictures. Twenty-three (21%) complications occurred, including two deaths. Sixteen patients experienced acute pain, requiring additional narcotics. There was one case of peritonitis and pancreatitis, and two of bacteremia. We compared our success and complication rates to those of endoscopic retrograde cholangiography (ERC) reported in the literature. We conclude that when a bile duct abnormality is clinically suspected, the incidence of pathology is sufficiently high to warrant direct visualization of the ducts in order to make an anatomic diagnosis, even if the intrahepatic ducts are not dilated. However, ERC has a better success rate and fewer complications than THC and it should be the initial invasive procedure.
Department of Radiology, University of Arkansas for Medical Sciences, Little Rock 72205.