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US-guided left-sided biliary drainage: nine-year experience

N Hayashi1, T Sakai, M Kitagawa

  • 1Department of Radiology, Fukui Medical School, Yoshida-gun, Japan.

Radiology
|July 1, 1997
PubMed
Summary
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Ultrasound-guided left-sided biliary drainage is feasible and safe for patients with a left hepatic duct branch diameter greater than 3 mm. This technique offers a successful approach for biliary drainage when visualized well.

Area of Science:

  • Interventional Radiology
  • Hepatobiliary Imaging
  • Medical Ultrasound Applications

Background:

  • Biliary drainage is crucial for managing obstructive jaundice and cholangitis.
  • Percutaneous biliary interventions are standard procedures, with ultrasound (US) guidance being a common modality.
  • Left-sided biliary access presents unique anatomical challenges compared to the right-sided approach.

Purpose of the Study:

  • To prospectively evaluate the feasibility and safety of left-sided biliary drainage using ultrasound guidance.
  • To determine the success rates and potential complications associated with this specific approach.

Main Methods:

  • A prospective study of 208 consecutive patients undergoing US-guided biliary drainage from July 1987 to July 1996.
  • Left-sided drainage was attempted when the left hepatic duct branch was well visualized by US.

Related Experiment Videos

  • Needle size (18-gauge or 21-gauge) was selected based on the visualized duct diameter (>3 mm or <3 mm, respectively).

    • Main Results:

    • Left-sided drainage was successful in 147 patients (71%) with well-visualized left hepatic duct branches (>3 mm diameter) using an 18-gauge needle.
    • In 26 patients with smaller duct diameters (<3 mm), 21-gauge needles were used; six (23%) left-sided attempts were unsuccessful, with five subsequently succeeding via a right-sided approach.
    • Two deaths (septic shock) and three cases of severe hemobilia were reported within 72 hours of drainage completion.

    Conclusions:

    • Ultrasound-guided left-sided biliary drainage is a highly successful and safe interventional radiology technique.
    • Success is strongly correlated with a left hepatic duct branch diameter greater than 3 mm and good US visualization.
    • Careful patient selection and appropriate needle selection are critical for optimizing outcomes and minimizing complications.