BILIARY INTERVENTION BY MEANS OF PERCUTANEOUS PUNCTURE OF THE ANTECOLIC JEJUNAL LOOP

PURPOSE: To evaluate the safety and efficacy of biliary intervention p erformed by means of percutaneous transjejunal access. MATERIALS AND M ETHODS: In 28 patients with conventional antecolic Roux-en-Y choledoch ojejunostomy or hepaticojejunostomy loops, 41 attempts were made at di rect percutaneous entry into the jejunal loop. Indications for previou s surgery included sclerosing cholangitis, orthotopic liver transplant ation, cholangiocarcinoma, bypass of benign iatrogenic strictures, and bypass of choledochal cyst. Roux-en-Y loops were directly accessed wi th single-wall, 19-gauge needles after localization by review of previ ous cholangiograms or computed tomographic (CT) scans and localization of surgical clips with fluoroscopy. RESULTS: The transjejunal approac h was successful in 36 of 41 attempts. In 30 cases, transhepatic punct ure was entirely avoided. There were four minor complications and one major complication of biliary sepsis. No procedure-related deaths occu rred. CONCLUSION: This transjejunal approach is an effective and safe route for a variety of percutaneous biliary procedures in patients wit h biliary-enteric anastomoses.