Transhepatic cholangiography: complicatons and use patterns of the fine-needle technique: a multi-institutional survey.

A multi-institutional survey of complications and use patterns of fine-needle transhepatic cholangiography (FNTC) was conducted, and the results were compared with those of transhepatic cholangiography using a large, sheathed needle and endoscopic retrograde cholangiopancreatography. Data were based on 2,006 procedures, including 293 from the authors' institution. The overall incidence of serious complications with FNTC was 3.4% (sepsis 1.40%, bile leakage 1.45%, intraperitoneal hemorrhage 0.35%, death 0.20%). The overall success rate was 97.8%; it was 99% when 12-14 needle passes were made, compared with only 95.5% when no more than 6 were made. It is concluded that 6 passes are not enough to exclude obstruction. One third of the patients with bile leakage had inadvertent puncture of the extrahepatic biliary tract. The pathogenesis of sepsis following FNTC is discussed and related to the author's recommendation of routine prior administration of ampicillin and gentamicin.