CO2 cholangiography

Evaluation of the benefit of carbon dioxide (CO2) as contrast medium to reduce intraductal manipulations in biliary drainage. In 8 patients with biliary occlusion demonstrated by cholangiography with iodinated contrast medium, percutaneous CO2 cholangiography was performed by manual injection of 30-50 ml CO2 using the same approach. Capability of CO2 to pass the obstruction and delineate distal parts of the common bile duct was evaluated. In 5 of 8 patients CO2 visualised additional segments of the occluded bile duct. In 4 patients the poststenotic bile duct was demonstrated with CO2. In one patient 2 cm of the obstructed duct segment was visualised. The intrahepatic duct system could not be examined sufficiently by CO2 administration. Because of its low viscosity, CO2 is a useful contrast medium to visualise the extrahepatic biliary system before performing an external-internal biliary drainage in biliary obstruction. Unnecessary intraductal manipulations may be reduced.