US-guided left-sided biliary drainage: nine-year experience.
OBJECTIVE
The feasibility and safety of left-sided biliary drainage with ultrasound (US) guidance were studied prospectively.


METHODS
From July 1987 to July 1996, 208 consecutive patients underwent US-guided biliary drainage; all were evaluated for left-sided drainage. Drainage procedure was begun with puncture of the hepatic duct branch of the lateral segment of the left lobe when the branch was well visualized with US; otherwise, a right-sided approach was used. When the hepatic duct branch diameter was greater than 3 mm, puncture was performed with an 18-gauge needle; smaller branches were punctured with 21-gauge needles.


RESULTS
In 147 (71%) patients, the left hepatic duct branch was well visualized with US, and the branch diameter was greater than 3 mm. In these patients, left-sided drainage with use of an 18-gauge needle was successful. In 26 (12%) patients, the left hepatic duct branch diameter was less than 3 mm, and drainage was initiated with a 21-gauge needle. In six (23%) of these 26 patients, left-sided drainage was unsuccessful, but five of these patients underwent successful US-guided drainage from the right hepatic duct branch. Two patients died of septic shock within 72 hours of completed drainage. Three patients experienced severe hemobilia.


CONCLUSIONS
US-guided left-sided biliary drainage is a highly successful and safe method when the left hepatic duct branch diameter is greater than 3 mm.
Hayashi
N
N
Department of Radiology, Fukui Medical School, Yoshida-gun, Japan.
Sakai
T
T
Kitagawa
M
M
Kimoto
T
T
Inagaki
R
R
Ishii
Y
Y
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001653:Bile Ducts, Intrahepatic; D002648:Child; D002675:Child, Preschool; D002779:Cholestasis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006431:Hemobilia / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012772:Shock, Septic / Q000209:etiology; D018084:Ultrasonography, Interventional / Q000379:methods*