Fine-needle transhepatic cholangiography: reflections after 450 cases.

Fine-needle transhepatic cholangiography is widely accepted as the procedure of choice for direct opacification of the bile ducts. A 5-year experience with 450 cases provided the basis for refinements of clinical applications and technique leading to an improved duct opacification rate, 93%, and only a 4.8% complication rate. Fluoroscopic monitoring of needle puncture to insure a controlled placement is essential. Familiarity with the normal anatomic course of the biliary ducts permits gravity maneuvers and positional changes to better delineate the exact area and appearance of the obstructing lesion. Cholangiographic aids, glucagon and barium duodenography, improve accuracy of cholangiographic interpretation. An algorithm for integration of fine-needle transhepatic cholangiography with other methods, sonography and computed tomography, emphasizes its pivotal position in patients with suspected surgical obstruction of the biliary ducts.