The failed transhepatic cholangiogram.

A study of percutaneous transhepatic cholangiograms in 94 consecutive patients revealed that success is largely determined by the number of passes attempted. Two of 43 patients with dilated intrahepatic ducts had unsuccessful cholangiograms, but in these patients only two and three passes were attempted. In the remaining 41 patients fewer than seven passes were required. In patients with nondilated ducts, the success rate bears an almost linear relationship to the number of attempted passes beyond the fourth pass. Since patient tolerance often limits the number of passes, careful technique is important; one such technique is described. In the cholangiogram failures with nondilated ducts, subsequent liver biopsy had a high diagnostic yield.