Percutaneous transhepatic cholangiography: comparison of success and risk using 19- versus 22-gauge needles

Percutaneous transhepatic cholangiography has become a well accepted and safe method of examining the biliary system. Recent reports emphasize the use of thin-guage Chiba needle, citing increased safety and accuracy, while others express preference for the larger sheathed needle for therapeutic drainage. A total of 80 procedures in 72 patients was reviewed to determine success rates relative to needle size in dilated or nondilated ducts. With a dilated biliary system, procedures using the large needle were successful in 92% (24/26) of the procedures versus 80.8% (21/26) using the Chiba needle; the differences were not statistically significant. Chiba needle studies were successful in 41.7% (10/24) of patients with nondilated ducts. The number of studies of nondilated ducts with the large needle was small and not statistically significant. Complication rates were comparable. Recommendations are made for needle choice in various patients.