Echo guided percutaneous transhepatic cholangiography with puncture transducer

The history of interventional ultrasound

Ultrasound has been used to guide interventional procedures for more than 30 years. Initial applications included biopsy techniques and simple aspiration of fluid collections. However, with improved sonographic imaging and the use of different ultrasonic probes as well as development of less invasive therapies, there has been an increase in the use of ultrasound to guide interventional procedures. Interventional ultrasound has become routine in most medical specialties. Because of the remarkable success of interventional procedures guided by sonography, combined with an outstanding safety record, there is no doubt that there will be a future increase in the number and types of interventional procedures performed under sonographic guidance.

Biliary drainage by ultrasound-guided puncture of the left hepatic duct

Percutaneous transhepatic biliary drainage under ultrasonic guidance was performed in 38 patients with obstructive jaundice due to malignancy (49 intubations). The method was used for palliation in 33 patients and for pre-operative drainage because of cholangitis in five patients. Puncture of the left lobar ducts was the method of choice (35 patients). Only in cases of poor visualisation of the left biliary ducts was right-sided drainage performed (three patients). Combined left- and right-sided drainage was necessary in nine patients. All attempts with ultrasound-guided punctures were successful. There were no complications related to the punctures. Delayed complications were cholangitis (10 patients) and bleeding (one patient). The advantages of the method compared with conventional percutaneous transhepatic biliary drainage and the advantages of the left liver lobe drainage are outlined.

Ultrasonically guided cholangiography and bile drainage

Ultrasonically guided percutaneous transhepatic cholangiography (UG-PTC), bile drainage (UG-PTBD) and gallbladder drainage procedure (UG-PTGBD), developed by us, were performed in 47, 183 and 36 patients, respectively. In 47 patients UG-PTC was successfully performed 51 times without complications. By UG-PTBD 220 intubations were carried out successfully and four attempts failed (1.8%). The main complication was that the catheter slipped out from the bile duct. It was experienced 27 times (12.3%) in 23 patients (12.4%) from two to 47 days after intubation. UG-PTGBD was successfully performed 36 times. Bleeding from the catheter was experienced in four patients. However, other complications such as cholascos were not experienced. Due to the development of ultrasonic diagnosis and the UG-PTBD procedure, the indications for percutaneous transhepatic cholangiography (PTC) are now limited. For differentiation of jaundice, ultrasonic examination takes over from PTC. For preparation of PTBD, thin needle cholangiography is no longer necessary because UG-PTBD is a single-step procedure without the need for cholangiography. Therefore, the indication for PTC is limited to patients with partial dilatation of intrahepatic bile ducts without jaundice, for example when only the left hepatic duct is dilated due to hepatolithiasis.