Radiologic intervention in the biliary tract performed at a central hospital

During the ten-year period 1987-96, 131 diagnostic percutaneous transhepatic cholangiographies (PTC) were performed in 103 patients due to obstructive jaundice. 54 cases of percutaneous transhepatic bile drainage (endoprosthesis) (PTBD) and 53 of percutaneous transhepatic external drainage (PTED) were also performed. In 89 patients (86%) the obstructive jaundice was caused by malignant disease. Puncture was done under fluoroscopic or ultrasonographic control. An 8 Fr. plastic endoprosthesis of 15 cm length was used for internal bile drainage, and a 7.6 Fr. 60 cm long catheter was used for external drainage. For combined external/internal drainage an 8.4 Fr. catheter of 60 cm length was used. 24 patients (23%) developed complications. Eight of these complications were serious, and three patients (2.5%) died as a result of the procedure. Three patients developed duodenal perforations. 11 out of 51 patients (20%) treated with endoprosthesis died within 30 days. Mean functioning time for endoprostheses was 128 days. Progress in radiologic intervention technique has changed the treatment of obstructive jaundice. In our view, endoscopic bile drainage should be the treatment of choice. Percutaneous transhepatic bile drainage is an alternative in cases where endoscopic therapy fails.