Fine-needle transhepatic cholangiography is a diagnostic tool often used for evaluating the biliary tree because of its wide availability and relatively low complication rate. Fine-needle cholangiography is primarily used in patients with obstructive jaundice with dilated ducts, but has been useful in patients with those entities that cause obstruction without dilatation (sclerosing cholangitis, ampullary stenosis, nonobstructing stone). We review our experience with over 700 cases of fine-needle cholangiography. The complication rate (due to bleeding, peritonitis, sepsis, and death) is less than 5%. The central role that fine-needle cholangiography plays in defining the site and cause of biliary obstruction is emphasized.