Relationship of biliary pressure to cholangiovenous reflux during endoscopic retrograde balloon catheter cholangiography.

In 32 patients undergoing endoscopic retrograde cholangiography with a balloon catheter, culture of bile, biliary pressure at maximal visualization of the biliary tract with iodinated contrast medium, serum iodine concentrations, and blood cultures before and after the procedure were obtained. There was a significant increase in the serum iodine concentration in five of nine patients (55.6%) with pressure between 22 cm H2O and 30 cm H2O and in nine of 13 patients (69.2%) with pressure above 30 cm H2O, while it remained low in 10 patients with pressure below 22 cm H2O. Two patients showed positive blood culture after the procedure, which yielded the same organisms as found in the bile. The biliary pressures in these two patients were 30.4 cm H2O and 38.0 cm H2O. These data suggest that during retrograde balloon catheter cholangiography: (1) cholangiovenous reflux of contrast medium develops with biliary pressure higher than 22 cm H2O, (2) the indicence of the cholangiovenous reflux increases as the pressure is elevated, and (3) regurgitation of bacteria occurs with pressure greater than 30 cm H2O. These findings are noteworthy because the number of patients who need direct cholangiography is increasing.