Transjugular Approach to Liver Biopsy and Transhepatic Cholangiography

Abstract

The percutaneous transjugular approach to liver biopsy and cholangiography (of Hanafee and Weiner) eliminates the necessity for traversing the peritoneal cavity and puncturing the liver capsule. The liver parenchyma is entered through the wall of a hepatic vein by a needle inserted into a catheter introduced percutaneously via the internal jugular vein. This approach offers a safe means for liver biopsy and transhepatic cholangiography in the patient with a bleeding tendency, high-grade obstructive jaundice or ascites. Acute cholangitis is the principal contraindication of this approach. The transjugular approach was used in 61 patients. Both biopsy and cholangiography were done in 36 patients, liver biopsy alone in eight patients, and cholangiography alone in 17 patients. Diagnostic biopsy specimens were obtained in 39 patients (89 per cent). Cholangiography succeeded in 29 of 31 patients (93 per cent) with enlarged intrahepatic ducts. There were no major complications. (N Engl J Med 289:227–231, 1973)