LIVER PHYSIOLOGY AND DISEASE A RANDOMIZED TRIAL OF PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY WITH THE CHIBA NEEDLE VERSUS ENDOSCOPIC RETROGRADE CHOLANGIOGRAPHY FOR BILE DUCT VISUALIZATION IN JAUNDICE

Sixty consecutive patients, who were deeply jaundiced or in whom intravenous cholangiography had failed, were randomized to retrograde endoscopic cholangiography or percutaneous transhepatic cholangiography with the skinny Chiba needle tech­ nique. Twenty-eight patients were assigned to retrograde cholangiography, which succeeded in 17 (65%). Percutaneous cholangiography was successful in 16 (50%) of the remaining 32 patients. When patients in whom the first procedure was unsuccessful were reinvestigated by the alternative technique. retrograde cholangiograms were obtained in 13 (81 %) of 16, and percutaneous cholangiograms in 8 (73%) of 11. Thus, one or the other technique was successful in 54 (90%) of 60 patients. When the results were analyzed separately for extrahepatic (29 patients) or intrahepatic (31 patients) cholestasis. percutaneous cholangiography was successful in 95% of patients with extrahepatic cholestasis but in only 25% with intrahepatic cholestasis. Endoscopic retrograde cholangiography succeeded in 63% of patients with extrahepatic and 76% with in­ trahepatic causes of cholestasis. Complications occurred only in patients with ex­ trahepatic cholestasis. Cholangitis and septicemia occurred in 1 patient after retrograde cholangiography and in 2 after the percutaneous technique. An intraperitoneal bile leak occurred in one other patient after percutaneous cholangiography. Percutaneous cholan­ giography with the narrow needle is a simple, inexpensive, and reliable method for demonstrating the biliary system and is usually successful when an extrahepatic cause of cholestasis is present. The occurrence of serious complications in patients with extrahepatic cholestasis, despite prophylactic antibiotics, makes provision for early surgery mandatory after both techniques.