Percutaneous transcatheterization of Roux-en-Y choledochojejunal anastomosis

Percutaneous access to the biliary system has been difficult in patients with a Roux-en-Y hepaticojejunostomy requiring repeated manipulation. The authors developed a combined percutaneous transhepatic and transjejunal approach that allows easy, safe, repeatable biliary access. The biliary system is transhepatically opacified and a 15-mm balloon catheter is manipulated into a jejunal loop. The balloon is inflated with contrast material, and under CT guidance the targeted bowel loop is punctured and a guide wire inserted. The wire is pulled transhepatically by a biliary basket and a U-tube positioned through the jejunal loop and liver. They present their experience with this technique