Prevention of Hemobilia during Percutaneous Biliary Drainage: Long-term Follow-up

Abstract

The authors evaluated a technique for the prevention of hemobilia when placing transhepatic biliary drainage catheters (THBDCs). Initially, 20 patients were randomized into two groups. In the control group, a THBDC was placed after blind needle passage without contrast material opacification of the needle tract. In the experimental group, the tract was studied and then abandoned if a major vascular structure was encountered. Once a tract was found that did not traverse a major vascular structure, a THBDC was placed. An additional 35 patients undergoing 40 procedures were studied with use of the technique as outlined for the original experimental group. The original experimental group patients and the additional 35 patients were followed for up to 3 years. There were three cases of hemobilia in the initial control group. None of the patients in the initial experimental group experienced hemobilia. In the additional 35 patients, there were three cases of bloody drainage from the THBDC; however, the etiology of hemobilia was not secondary to transgression of a vascular structure. Visualization of the tract prevents the usage of tracts that communicate with large vascular structures. This technique reduces the incidence of hemobilia when placing THBDCs.