First experiences in CT-guided percutaneous transhepatic biliary decompression by means of real-time CT fluoroscopy

Background: Computed tomographic fluoroscopy (CTF), also called real-time CT, is increasingly used in interventional radiology but has not yet been recommended to guide percutaneous transhepatic biliary decompression (PTBD). We report our early clinical experiences with CTF-guided PTBD. Methods: Sixteen consecutive patients underwent PTBD under CTF guidance because of obstructive jaundice caused by malignant tumor (11 cases of carcinoma of the bile duct, four cases of pancreatic cancer, and one case of metastasis). CTF-guided PTBD was performed on a helical CT scanner and a surgical C arm. Main target parameters were the success and complication rates, the number of necessary punctures, the time needed for successful puncture of a suitable bile duct, and the patients' radiation exposure. Results: CTF-guided punctures of the bile duct for PTBD were successful on the first trial in 10 cases; in six patients, two hits were necessary. The time needed to hit a suitable bile duct was 6–21 s (median = 13 s). Therefore, the radiation exposure (skin) was 27–94.5 mSv. The additional implantation and stenting of the bile duct by means of the surgical C arm was uneventful in 15 cases. In one case, only external drainage could be achieved. Complications did not occur. Conclusion: CTF enables good visualization of the most suitable duct for puncture. Therefore, subsequent recanalization seems to be easier than other methods. Received: 19 June 2000/Accepted: 26 July 2000