Journal of Ultrasound

, Volume 22, Issue 4, pp 437–445 | Cite as

Safety and effectiveness of ultrasound-guided percutaneous transhepatic biliary drainage: a multicenter experience

  • Francesco GiurazzaEmail author
  • Fabio Corvino
  • Andrea Contegiacomo
  • Paolo Marra
  • Nicola Maria Lucarelli
  • Marco Calandri
  • Mattia Silvestre
  • Antonio Corvino
  • Pierleone Lucatelli
  • Francesco De Cobelli
  • Raffaella Niola
  • Maurizio Cariati
  • Italian College of Interventional Radiology (ICIR) Rising Stars Group
Original Paper



Aim of this study is to describe a multicenter experience on percutaneous transhepatic biliary drainage (PTBD) performed with ultrasound-guidance to access the biliary tree, focusing on safety, effectiveness and radiation dose exposure; differences between right- and left-sided approaches have been also evaluated.


This is a multicenter prospective single-arm observational study conducted on patients affected by biliary tree stenosis/occlusion with jaundice and endoscopically inaccessible. The procedures have been performed puncturing the biliary system under US guidance and crossing the stenosis/occlusion under fluoroscopy. Beam-on time and X-ray dose have been evaluated.


117 patients affected by biliary tree stenosis/occlusion not manageable with an endoscopic approach have been included in this analysis. The biliary stenosis/occlusion was malignant in 90.8% and benign in 9.2%. Technical success, considered as positioning of a drainage tube into the biliary tree, was 100%. Overall clinical success, considered as decrease in total bilirubin level after a single procedure, was 95.7%. The overall mean number of liver punctures to catheterize the biliary tree was 1.57. The mean total beam-on time was 570.4 s; the mean dose-area product was 37.25 Gy cm2. No statistical significant differences were observed in terms of technical and dosimetry results according to right-sided and left-sided procedures. Complications rate recorded up to 30 days follow-up was 10.8%, all of minor grades.


In this series US guidance to access the biliary tree for PTBD was a safe and effective technique with an acceptable low-grade complications rate; the reported radiation dose is low.

Graphic abstract


Biliary drainage Percutaneous Ultrasound Complications Radiation dose 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual patients included in the study.

Human and animal and rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


  1. 1.
    Saad WE, Wallace MJ, Wojak JC, Kundu S, Cardella JF (2010) Quality improvement guidelines for percutaneous transhepatic cholangiography, biliary drainage, and percutaneous cholecystostomy. J Vasc Interv Radiol 21(6):789–795CrossRefGoogle Scholar
  2. 2.
    Nennstiel S, Treiber M, Faber A et al (2019) Comparison of ultrasound and fluoroscopically guided percutaneous transhepatic biliary drainage. Dig Dis 37(1):77–86CrossRefGoogle Scholar
  3. 3.
    Kühn JP, Busemann A, Lerch MM, Heidecke CD, Hosten N, Puls R (2010) Percutaneous biliary drainage in patients with nondilated intrahepatic bile ducts compared with patients with dilated intrahepatic bile ducts. AJR Am J Roentgenol 195:851–857CrossRefGoogle Scholar
  4. 4.
    Oh HC, Lee SK, Lee TY, Kwon S, Lee SS, SeoDW Kim MH (2007) Analysis of percutaneous transhepatic cholangioscopy-related complications and the risk factors for those complications. Endoscopy 39:731–736CrossRefGoogle Scholar
  5. 5.
    Weber A, Gaa J, Rosca B et al (2009) Complications of percutaneous transhepatic biliary drainage in patients with dilated and nondilated intrahepaticbile ducts. Eur J Radiol 72:412–417CrossRefGoogle Scholar
  6. 6.
    Wagner A, Mayr C, Kiesslich T, Berr F, Friesenbichler P, Wolkersdörfer GW (2017) Reduced complication rates of percutaneous transhepatic biliary drainage with ultrasound guidance. J Clin Ultrasound 45:400–407CrossRefGoogle Scholar
  7. 7.
    Kandarpa K, Aruny JE (2002) Handbook of interventional radiologic procedures, 3rd edn. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  8. 8.
    Dumonceau JM, Tringali A, Blero D et al (2012) European Society of Gastrointestinal Endoscopy: Biliary stenting: indications, choice of stents and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy 44:277–298CrossRefGoogle Scholar
  9. 9.
    Kozlov AV, Polikarpov AA, Oleshchuk NV, Tarazov PG (2002) Comparative assessment of percutaneous transhepatic cholangio drainage under roentgenoscopy and US guidance. Vestn Rentgenol Radiol 4:30–33Google Scholar
  10. 10.
    Makuuchi M, Bandai Y, Ito T et al (1980) Ultrasonically guided percutaneous transhepatic bile drainage: a single-step procedure without cholangiography. Radiology 136:165–169CrossRefGoogle Scholar
  11. 11.
    Sukigara M, Taguchi Y, Watanabe T, Koshizuka S, Koyama I, Omoto R (1994) Percutaneous transhepatic biliary drainage guided by color Doppler echography. Abdom Imaging 19:147–149CrossRefGoogle Scholar
  12. 12.
    Lee W, Kim GC, Kim JY et al (2008) Ultrasound and fluoroscopy guided percutaneous transhepatic biliary drainage in patients with nondilated bile ducts. Abdom Imaging 33:555–559CrossRefGoogle Scholar
  13. 13.
    Ignee A, Cui X, Schuessler G, Dietrich CF (2015) Percutaneous transhepatic cholangiography and drainage using extravascular contrast enhanced ultrasound. Z Gastroenterol 53(5):385–390CrossRefGoogle Scholar
  14. 14.
    Patel IJ, Davidson JC, Nikolic B et al (2012) Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol 23(6):727–736CrossRefGoogle Scholar
  15. 15.
    Filippiadis DK, Binkert C, Pellerin O, Hoffman RT, Krajina A, Pereira PL (2017) Cirse quality assurance document and standards for classification of complications: the cirse classification system. Cardiovasc Intervent Radiol 40:1141–1146CrossRefGoogle Scholar
  16. 16.
    Glenn F, Evans JA, Mujahed Z, Thorbjarnarson B (1962) Percutaneous transhepatic cholangiography. Ann Surg 156:451–462CrossRefGoogle Scholar
  17. 17.
    Takada T, Yasuda H, Hanyu F (1995) Technique and management of percutaneous transhepatic cholangial drainage for treating an obstructive jaundice. Hepatogastroenterology 42:317–322PubMedGoogle Scholar
  18. 18.
    Righi D, Doriguzzi A, Rampado O et al (2008) Interventional procedures for biliary drainage with bilioplasty in paediatric patients: dosimetric aspects. Radiol Med 113:429–438CrossRefGoogle Scholar
  19. 19.
    Houghton EJ, Zeledon M, Acquafresca P, Finger C, Palermo M, Gimenez ME (2018) Prospective comparison of bleeding complications between right and left approaches in percutaneous biliary drainage. Surg Laparosc Endosc Percutan Tech. CrossRefPubMedGoogle Scholar
  20. 20.
    Corvino F, Centore L, Soreca E, Corvino A, Farbo V, Bencivenga A (2016) Percutaneous “Y” biliary stent placement in palliative treatment of type 4 malignant hilar stricture. J Gastrointest Oncol 7(2):255–261PubMedPubMedCentralGoogle Scholar
  21. 21.
    Kloeckner R, Bersch A, Pinto dos Santos D, Schneider J, Duber C, Pitton MC (2012) Radiation Exposure in nonvascular fluoroscopy-guided interventional procedures. Cardiovasc Intervent Radiol 35:613–620CrossRefGoogle Scholar
  22. 22.
    Padovani R, Compagnone G, D’Ercole L, Orlacchio A, Bernardi G, Rosi A, Campanella F (2017) Livelli diagnostici di riferimento nazionali per la radiologia diagnostica e interventistica. Roma: Istituto Superiore di Sanità (Rapporti ISTISAN 17/33)Google Scholar
  23. 23.
    Kinoshita M, Shirono R, Takechi K et al (2017) The usefulness of virtual fluoroscopic preprocedural planning during percutaneous transhepatic biliary drainage. Cardiovasc Intervent Radiol 40:894–901CrossRefGoogle Scholar
  24. 24.
    Choi SH, Gwon DI, Ko GY et al (2011) Hepatic arterial injuries in 3110 patients following percutaneous biliary drainage. Radiology 261:969–975CrossRefGoogle Scholar
  25. 25.
    Rivera-Sanfeliz GM, Assar OS, LaBerge JM et al (2004) Incidence of important hemobilia following transhepatic biliary drainage left-sided versus right-sided approaches. Cardiovasc Interv Radiol 27:137–139CrossRefGoogle Scholar
  26. 26.
    Lucatelli P, Corradini SG, Corona M et al (2016) Risk factors for immediate and delayed-onset fever after pecutaneous transhepatic biliary drainage. Cardiovasc Interv Radiol 39(5):746–755CrossRefGoogle Scholar
  27. 27.
    Baniya R, Upadhaya S, Madala S, Subedi SC, Mohammed TS, Bachuwa G (2017) Endoscopic ultrasound-guided biliary drainage versus percutaneous transhepatic biliary drainage after failed endoscopic retrograde cholangiopancreatography: a meta-analysis. Clin Exp Gastroenterol 10:67–74CrossRefGoogle Scholar
  28. 28.
    Holt BA, Hawes R, Hasan M et al (2016) Biliary drainage: role of EUS guidance. Gastrointest Endosc 83(1):160–165CrossRefGoogle Scholar
  29. 29.
    De Cobelli F, Marra P, Diana P, Brembilla G, Venturini M (2017) Therapeutic EUS: Biliary drainage—the interventional radiologist’s perspective. Endosc Ultrasound 6(Suppl 3):S127–S131CrossRefGoogle Scholar
  30. 30.
    Vidili G, De Sio I, D’Onofrio M et al (2019) SIUMB guidelines and recommendations for the correct use of ultrasound in the management of patients with focal liver disease. J Ultrasound 22(1):41–51CrossRefGoogle Scholar
  31. 31.
    Jenssen C, Brkljacic B, Hocke M et al (2015) EFSUMB guidelines on interventional ultrasound (INVUS), Part VI—ultrasound-guided vascular interventions. Ultraschall Med. CrossRefPubMedGoogle Scholar
  32. 32.
    Lamperti M, Bodenham AR, Pittiruti M et al (2012) International evidence-based recommendations on ultrasound-guidedvascular access. Intensive Care Med 38:1105–1117CrossRefGoogle Scholar
  33. 33.
    Tuna Katircibaşi M, Güneş H, Çağri Aykan A, Aksu E, Özgül S (2018) Comparison of ultrasound guidance and conventional method for common femoral artery cannulation: a prospective study of 939 patients. Acta Cardiol Sin 34(5):394–398PubMedPubMedCentralGoogle Scholar
  34. 34.
    Corvino A, Sandomenico F, Setola SV, Corvino F, Tafuri D, Catalano D (2019) Morphological and dynamic evaluation of complex cystic focal liver lesions by contrast-enhanced ultrasound: current state of the art. J Ultrasound 1:3. CrossRefGoogle Scholar
  35. 35.
    Corvino A, Catalano O, Corvino F, Sandomenico F, Petrillo A (2017) Diagnostic performance and confidence of contrast-enhanced ultrasound in the differential diagnosis of cystic and cystic-like liver lesions. AJR Am J Roentgenol 209(3):W119–W127CrossRefGoogle Scholar

Copyright information

© Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB) 2019

Authors and Affiliations

  • Francesco Giurazza
    • 1
    Email author
  • Fabio Corvino
    • 1
  • Andrea Contegiacomo
    • 2
  • Paolo Marra
    • 3
  • Nicola Maria Lucarelli
    • 4
  • Marco Calandri
    • 5
  • Mattia Silvestre
    • 1
  • Antonio Corvino
    • 6
  • Pierleone Lucatelli
    • 7
  • Francesco De Cobelli
    • 3
  • Raffaella Niola
    • 1
  • Maurizio Cariati
    • 8
  • Italian College of Interventional Radiology (ICIR) Rising Stars Group
  1. 1.Vascular and Interventional Radiology DepartmentCardarelli HospitalNaplesItaly
  2. 2.Fondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
  3. 3.Radiology DepartmentIRCCS Ospedale San Raffaele e Università Vita-SaluteMilanItaly
  4. 4.Interdisciplinary Department of Medicine – Section of Diagnostic ImagingAldo Moro University of Bari Medical SchoolBariItaly
  5. 5.Diagnostic and Interventional Radiology Unit, Oncology DepartmentTurin UniversityTurinItaly
  6. 6.Motor Science and Wellness DepartmentUniversity of Naples “Parthenope”NaplesItaly
  7. 7.Interventional Radiology UnitDepartment of Radiological, Oncological and Anatomopathological SciencesRomeItaly
  8. 8.Diagnostic-Therapeutic Advanced Technology DepartmentASST Santi Paolo e CarloMilanItaly

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