Limited usefulness of carbon dioxide as a contrast agent for cholangiography

Carbon dioxide (CO2) was unsuccessfully used as a biliary contrast agent in 9 of 10 patients undergoing percutaneous transhepatic cholangiography prior to biliary drainage. The technique involved hand injection of 10-20 cc CO2 through the Chiba needle in an attempt to fill preferentially the anterior biliary radicals. Although CO2 remains a useful agent in many instances, particularly for percutaneous nephrostomy, its usefulness in the biliary tract is severely limited.