Sonographic needle guidance in cholangiography in children

PURPOSE: To evaluate feasibility and benefits of sonographic guidance of pe rcutaneous transhepatic cholangiography (PTC) in children with liver transp lants. MATERIALS AND METHODS: The authors prospectively followed 24 PTC procedures in 19 pediatric patients (11 females, 8 males; age 3 months to 17 years) r andomized to fluoroscopic or sonographic guidance. The number of needle pas ses, the contrast material dose, fluoroscopy time, and procedure time for e ach procedure were recorded. All patients were transplant recipients-six wh ole and 13 reduced-size grafts. Cases were randomly assigned to two groups: group I, fluoroscopically guided PTC (12 procedures); group II, sonographi cally guided PTC (12 procedures). RESULTS: The technical success rate was 92% (11 of 12) for each group. In g roup I, there were two procedure-related complications: postprocedural feve r caused by biliary to portal vein fistula, and peritoneal bleeding requiri ng surgery. In group II, there were no procedure-related complications. A m ean of 8.2 +/- 3.7 needle passes were required in group I compared to only 2.0 +/- 1.3 in group II (P < .0001). A mean contrast material dose of 19.5 mL +/- 13.4 was required in group I compared to only 2.5 mL +/- 1.9 in grou p II (P < .001). A mean procedure time of 15.7 minutes +/- 7.4 was required in group I compared to only 6.1 minutes +/- 4.5 in group II (P < .001). A mean fluoroscopy time of 10.4 minutes +/- 5.0 was required in group I compa red to only 1.0 minutes +/- 0.7 in group II (P < .0001). CONCLUSION: In pediatric patients who have undergone liver transplantation, sonographic guidance significantly decreases the number of needle passes, contrast material dose, and fluoroscopy time required for PTC.