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Published on: October 20, 2018
Bile duct dilatation as a key determinant of technical success and access-related challenges in percutaneous
Erdi Tangobay1, Saffet Ozturk2, Umut Asfuroglu2
1Department of Radiology, Ankara Etlik City Hospital, Ankara, Turkey. erditangobay@gmail.com.
Objectives:
To compare technical success, procedural metrics, and complication patterns of percutaneous transhepatic biliary drainage (PTBD) in dilated versus nondilated biliary systems.
Methods:
This retrospective single-center study included 440 PTBD procedures performed in 388 patients between October 2022 and June 2025. Patients undergoing concomitant biliary interventions or repeat attempts within 7 days were excluded. Biliary ductal status was determined using preprocedural CT and intraprocedural ultrasonography, with dilatation defined as a largest visible intrahepatic bile duct diameter > 2 mm. Procedural time was subdivided into an access phase (T1 time: from the first fluoroscopic image to cholangiography) and a catheter-placement phase (T2 time: from cholangiography to final catheter placement). Technical success, total procedure time, T1 and T2 times, fluoroscopy time, radiation dose, and complications graded according to CIRSE criteria were recorded. Comparative analyses were performed between dilated and nondilated ducts and subgroup evaluation was conducted within nondilated ducts for bile leakage versus other indications.
Results:
PTBD was performed in 318 dilated and 122 nondilated ducts. Technical success was significantly lower in nondilated ducts (89.3% vs. 99.7%, p < 0.001). Nondilated procedures demonstrated prolonged total procedure time, longer T1 time, and greater fluoroscopy time and radiation exposure (all p < 0.001), while T2 duration remained similar. Overall complication rates were comparable; however, bleeding complications were more frequent in nondilated ducts (6.6% vs. 1.3%, p = 0.005). Cholangitis predominantly occurred in dilated ducts (6.0% vs. 0.8%, p = 0.019).
Conclusion:
Nondilated ducts pose greater technical difficulty and procedural burden during PTBD, reflected by lower success rates and increased bleeding risk, whereas dilated ducts have a higher propensity for cholangitis. Recognizing ductal status is essential for procedural planning and risk stratification.
