Endoscopic nasobiliary drain placement facilitates subsequent percutaneoustranshepatic cholangiography

Background: Percutaneous biliary drainage is an established alternative to ERCP for managing bile duct obstruction. Although generally safe and effect ive, percutaneous drainage has its risks and is technically more difficult in patients with nondilated bile ducts. We report the use of nasobiliary dr ains and subsequent nasobiliary drain cholangiography to facilitate percuta neous biliary drainage by providing a target for accessing intrahepatic bil e ducts. Methods/Results: Nine patients who were identified as requiring percutaneou s biliary drainage underwent nasobiliary tube placement at completion of ER CP. Five of 9 patients had generalized intrahepatic ductal dilatation; in 4 patients, dilatation was focal or absent. Following nasobiliary drain chol angiography, percutaneous needle puncture of a bile duct was successful in all patients, in most cases with only a single puncture of the liver capsul e. No procedural complications were encountered. Conclusion: Nasobiliary drain placement with subsequent nasobiliary drain c holangiography facilitates percutaneous biliary drainage and may be especia lly helpful in patients with nondilated intrahepatic bile ducts.