Transhepatic cholangiography: complicatons and use patterns of the fine-needle technique: a multi-institutional survey.

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Abstract
A multi-institutional survey of complications and use patterns of fine-needle transhepatic cholangiography (FNTC) was conducted and compared with transhepatic cholangiography using a large, sheathed needle and endoscopic retrograde cholangiopancreatography. Procedures (2006) were surveyed. The overall incidence of serious complications with FNTC was 3.4% (sepsis 1.40%, bile leakage 1.45%, intraperitoneal hemorrhage 0.35% and death 0.20%). The overall success rate was 97.8%; 99% when 12-14 needle passes were made and only 95.5% when no more than 6 were made. Six passes apparently are not enough to exclude obstruction. One-third of the patients with bile leakage had inadvertent puncture of the extrahepatic biliary tract. The pathogenesis of sepsis following FNTC is discussed and related to routine prior administration of ampicillin and gentamicin.