Access for percutaneous transhepatic cholangioscopy in patients with nondilated bile ducts using nasobiliary catheter cholangiography and oblique fluoroscopy

Background: Percutaneous transhepatic biliary drainage is required for perc utaneous transhepatic cholangioscopy, However, puncture of nondilated bile ducts under ultrasonographic guidance is difficult. Methods: In 10 patients with no ultrasonographic evidence of intrahepatic b ile duct dilatation, percutaneous transhepatic biliary drainage was perform ed under fluoroscopic guidance using cholangiography obtained via a nasobil iary drainage catheter. Direct puncture was performed by means of a left ve ntral approach using oblique C-arm fluoroscopy. Results: Bile duct puncture was successful in all patients. There were no p rocedure-related complications. Subsequent cholangioscopy was successful in all patients. Conclusions: Direct puncture using nasobiliary drainage cholangiography and oblique fluoroscopy is a useful method when cholangioscopy is necessary in patients with nondilated bile ducts.