Transjugular Approach to Liver Biopsy and Transhepatic Cholangiography

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). THE standard transperitoneal approach to aspiration liver biopsy and cholangiography carries a high risk of hemoperitoneum or bile peritonitis in patients with a bleeding tendency, abundant ascites or high-grade obstructive jaundice. The transjugular approach,¹,² in which the liver parenchyma is entered through the wall of a hepatic vein, offers a safe means of accomplishing both objectives in these clinical conditions. In this technic, a catheter, percutaneously introduced into the internal jugular vein, is advanced down through the superior vena cava, right atrium and inferior vena cava into a hepatic vein. A long, curved needle, inserted through the catheter, is used.