US-guided left-sided biliary drainage: nine-year experience.

PURPOSE: The feasibility and safety of left-sided biliary drainage with ultrasound (US) guidance were studied prospectively. MATERIALS AND METHODS: From July 1987 to July 1996, 208 consecutive patients underwent US-guided biliary drainage; all were evaluated for left-sided drainage. Drainage procedure was begun with puncture of the hepatic duct branch of the lateral segment of the left lobe when the branch was well visualized with US; otherwise, a right-sided approach was used. When the hepatic duct branch diameter was greater than 3 mm, puncture was performed with an 18-gauge needle; smaller branches were punctured with 21-gauge needles. RESULTS: In 147 (71%) patients, the left hepatic duct branch was well visualized with US, and the branch diameter was greater than 3 mm. In these patients, left-sided drainage with use of an 18-gauge needle was successful. In 26 (12%) patients, the left hepatic duct branch diameter was less than 3 mm, and drainage was initiated with a 21-gauge needle. In six (23%) of the...