Interventional biliary radiology.

The biliary tract may be approached through surgical drainage tracts, percutaneously through the liver, and perorally through the duodenum. Removal of retained stones through a surgical drainage tract can be performed on outpatients with 90%-95% success in experienced hands. The percutaneous approach through the liver is useful to drain malignant obstructions before surgical or drug treatment and can offer catheter stent palliation for tumors in the porta hepatis. Benign strictures also may be drained and dilated transhepatically. Ascites and multiple intrahepatic obstructions are relative contraindications to transhepatic entry. Hemorrhage is the most frequent serious complication, occurring in about 5% of procedures. Indwelling endoprostheses are preferred to external catheters to reduce the psychologic trauma of the catheter. A new procedure for inserting large endoprostheses by a combined peroral/transhepatic approach has the advantage of requiring only a small transhepatic tract.