Evaluation of cholangeographic procedures in diagnosis of obstructive jaundice.

Endoscopic retrograde cholangiography, percutaneous transhepatic cholangiography with external bile drainage and a combined method utilizing both procedures were evaluated in 187 patients with obstructive jaundice. Ductal obstructive regions were located in 90 per cent of cases by endoscopic retrograde cholangiography, and 55 per cent of these were correctly diagnosed. Complications were observed in 7.9 per cent with a mortality rate of 2.9 per cent. The most serious complication was cholangitic sepsis. By percutaneous transhepatic cholangiography with external bile drainage, ductal obstructive regions were correctly located in 82 per cent, 37 per cent of these patients were correctly diagnosed. Complications occurred in 9.2 per cent with a mortality rate of 1.5 per cent. The most serious complication was massive bleeding. Successful external bile drainage could be obtained in most cases. The combined method overcomes the disadvantages of the single methods and the cause of obstructive jaundice can be diagnosed more precisely. The surgeon has a better knowledge of the type and the extent of the lesion prior to definitive surgery and can operate more safely on patients with obstructive jaundiced when the serum total bilirubin, has decreased to a level below 5 mg/dl.