title: Peripheral portal vein-oriented non-dilated bile duct puncture for percutaneous transhepatic biliary drainage.
abstract: OBJECTIVE
  To evaluate the efficacy of peripheral portal vein (PV)-oriented non-dilated bile duct (BD) puncture for percutaneous transhepatic biliary drainage (PTBD).
  
  
  METHODS
  Thirty-five patients with non-dilated BDs underwent PTBD for the management of various biliary disorders, including benign bilioenteric anastomotic stricture (n = 24), BD stricture (n = 5) associated with iatrogenic BD injury, and postoperative biliary leakage (n = 6). Under ultrasonographic guidance, percutaneous transhepatic puncture using a 21-G needle was performed along the running course of the peripheral targeted non-dilated BD (preferably B6 for right-sided approach, and B3 for left-sided approach) or along the accompanying PV when the BD was not well visualized. This technique could provide an appropriate insertion angle of less than 30° between the puncture needle and BD running course. The puncture needle was then advanced slightly beyond the accompanying PV. The needle tip was moved slightly backward while injecting a small amount of contrast agent to obtain the BD image, followed by insertion of a 0.018-inch guide wire (GW). A drainage catheter was then placed using a two-step GW method.
  
  
  RESULTS
  PTBD was successful in 33 (94.3%) of the 35 patients with non-dilated intrahepatic BDs. A right-sided approach was performed in 25 cases, while a left-sided approach was performed in 10 cases. In 31 patients, the first PTBD attempt proved successful. Four cases required a second attempt a few days later to place a drainage catheter. PTBD was successful in two cases, but the second attempt also failed in the other two cases, probably due to poor breath-holding ability. Although most patients (n = 26) had been experiencing cholangitis with fever (including septic condition in 8 cases) before PTBD, only 5 (14.3%) patients encountered PTBD procedure-related complications, such as transient hemobilia and cholangitis. No major complications such as bilioarterial fistula or portal thrombosis were observed. There was no mortality in our series.
  
  
  CONCLUSIONS
  Peripheral PV-oriented BD puncture for PTBD in patients with non-dilated BDs is a safe and effective procedure for BD stricture and postoperative bile leakage.
authors.affiliation: Hiroaki Shimizu, Atsushi Kato, Tsukasa Takayashiki, Satoshi Kuboki, Masayuki Ohtsuka, Hideyuki Yoshitomi, Katsunori Furukawa, Masaru Miyazaki, Department of General Surgery, Chiba University Graduate School of Medicine, Chiba City, Chiba Prefecture 260-8670, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shimizu
authors.affiliation: Hiroaki Shimizu, Atsushi Kato, Tsukasa Takayashiki, Satoshi Kuboki, Masayuki Ohtsuka, Hideyuki Yoshitomi, Katsunori Furukawa, Masaru Miyazaki, Department of General Surgery, Chiba University Graduate School of Medicine, Chiba City, Chiba Prefecture 260-8670, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kato
authors.affiliation: Hiroaki Shimizu, Atsushi Kato, Tsukasa Takayashiki, Satoshi Kuboki, Masayuki Ohtsuka, Hideyuki Yoshitomi, Katsunori Furukawa, Masaru Miyazaki, Department of General Surgery, Chiba University Graduate School of Medicine, Chiba City, Chiba Prefecture 260-8670, Japan.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Takayashiki
authors.affiliation: Hiroaki Shimizu, Atsushi Kato, Tsukasa Takayashiki, Satoshi Kuboki, Masayuki Ohtsuka, Hideyuki Yoshitomi, Katsunori Furukawa, Masaru Miyazaki, Department of General Surgery, Chiba University Graduate School of Medicine, Chiba City, Chiba Prefecture 260-8670, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kuboki
authors.affiliation: Hiroaki Shimizu, Atsushi Kato, Tsukasa Takayashiki, Satoshi Kuboki, Masayuki Ohtsuka, Hideyuki Yoshitomi, Katsunori Furukawa, Masaru Miyazaki, Department of General Surgery, Chiba University Graduate School of Medicine, Chiba City, Chiba Prefecture 260-8670, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ohtsuka
authors.affiliation: Hiroaki Shimizu, Atsushi Kato, Tsukasa Takayashiki, Satoshi Kuboki, Masayuki Ohtsuka, Hideyuki Yoshitomi, Katsunori Furukawa, Masaru Miyazaki, Department of General Surgery, Chiba University Graduate School of Medicine, Chiba City, Chiba Prefecture 260-8670, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Yoshitomi
authors.affiliation: Hiroaki Shimizu, Atsushi Kato, Tsukasa Takayashiki, Satoshi Kuboki, Masayuki Ohtsuka, Hideyuki Yoshitomi, Katsunori Furukawa, Masaru Miyazaki, Department of General Surgery, Chiba University Graduate School of Medicine, Chiba City, Chiba Prefecture 260-8670, Japan.
authors.forename: Katsunori
authors.initials: K
authors.lastname: Furukawa
authors.affiliation: Hiroaki Shimizu, Atsushi Kato, Tsukasa Takayashiki, Satoshi Kuboki, Masayuki Ohtsuka, Hideyuki Yoshitomi, Katsunori Furukawa, Masaru Miyazaki, Department of General Surgery, Chiba University Graduate School of Medicine, Chiba City, Chiba Prefecture 260-8670, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Miyazaki
mesh_terms: D000328:Adult; D000368:Aged; D059925:Anatomic Landmarks; D001652:Bile Ducts / Q000000981:diagnostic imaging*; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D057785:Catheters; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles; D011169:Portal Vein / Q000000981:diagnostic imaging*; D011677:Punctures; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
keywords: Cholangitis; Non-dilated bile duct; Obstructive jaundice; Percutaneous transhepatic biliary drainage