Abstract
Between 2006 and 2013, we performed X-ray-guided percutaneous transhepatic biliary drainage (PTBD) in five patients with non-dilated intrahepatic bile duct (diameter less than 1 mm) . The endoscopic approach was difficult in these patients due to their past history of gastric/duodenal surgery (anastomotic leakage after total gastrectomy, n＝3; cholangitis after total gastrectomy, n=1；anastomotic leakage after partial duodenal resection, n＝1). The patients were placed in the supine position, and a puncture was made between the right 7th and 8th ribs, 3 cm lateral to the bottom line of the 11th thoracic vertebrae (right transthoracic approach). This procedure was performed with local anesthesia under X-ray guidance. A contrast agent was injected to identify the intrahepatic bile duct, followed by careful insertion of a 0.018-inch guidewire. A two-step Seldinger technique was then used to place the 7-Fr PTBD catheter. The biliary drainage catheter was placed successfully in all the patients, with effective reduction of the serum total bilirubin. X-ray-guided PTBD can be performed safely in patients with a non-dilated bile duct in whom the endoscopic approach is difficult.
