Percutaneous biliary drainage: technical and catheter-related problems in 200 procedures.

Analysis of 200 consecutive percutaneous biliary drainages revealed critical technical and clinical components not previously emphasized. In this series, successful drainage was achieved in 188 (94%) of 200 instances, and 67 (36%) of the 188 patients were discharged from the hospital without formal surgical exploration. Severe acute periprocedural complications occurred in 16 (8%) of the 200 procedures (death, three cases; septicemia, seven; and bleeding, six). Minor periprocedural complications occurred in 39 (20%) of the 200 instances (postprocedural fever, 21; hemobilia, 18). Significant delayed in-hospital complications with catheter function occurred in 22% of procedures (postclamping cholangitis, 36; catheter leaking eight). In outpatients under chronic catheter care, complications including inadvertent catheter dislodgment, tube obstruction, and cholangitis occurred at least once in most patients. Details of the etiology, prevention, and management of these major and minor complications are outlined.