Percutaneous transhepatic cholangiography, drainage, and biopsy in patients with malignant biliary obstruction. An alternative to surgery.

We retrospectively reviewed our experience with 100 patients with malignant biliary obstruction who underwent percutaneous transhepatic cholangiography alone or in combination with percutaneous drainage. On the basis of this study, we found percutaneous transhepatic cholangiography to be a safe and effective procedure for demonstrating the site, nature, and extent of obstructive lesions. Percutaneous cholangiography was successful in 98 percent of patients, and only one patient (4.1 percent) had a significant complication. Likewise, percutaneous drainage has been highly successful in providing palliative biliary drainage in patients with unresectable malignancies. Percutaneous drainage was successful in 74 of 76 patients (97.4 percent). Five of these patients (6.6 percent) had significant complications, including one death (1.3 percent). The mean survival period of patients with carcinoma of the bile ducts was 29 months, whereas for those with carcinoma of the pancreas it was 3.4 months. Thus, mortality and complication rates were lower, and patient survival rates were similar or improved when compared with those of patients palliated by surgical bypass. Percutaneous drainage thus provides a satisfactory alternative to surgery. Biopsy performed in conjunction with these procedures can often provide a definitive diagnosis. Final tissue diagnoses were made in 20 of 23 patients (87 percent) by transcatheter or percutaneous biopsy.