Refinements in Chiba needle trans hepatic cholangiography.

The recent wide acceptance of Chiba needle transhepatic cholangiography prompted this elaboration of present techniques, intraprocedure observations, and special interpretive considerations based on a series of 100 consecutive examinations. The established safety margin of this technique now permits up to 15 needle passes to obtain a cholangiogram; thus success rates of duct opacification presently approach 100%. Special phenomena related to the small caliber of the needle include duct filling from "invisible" radicles, perivenous or periductal dissection of contrast, and pseudolesions in an incompletely decompressed stagnant bile column. The role of fine needle cholangiography in light of other present day technology for evaluating obstructive jaundice (ultrasonography, computed tomography, and endoscopic retrograde cholangiography) is discussed.