Air cholangiogram: a new technique for biliary imaging during ERCP

BackgroundPalliation of patients with malignant hilar stenosis by stent insertion is fraught with risk of cholangitis because of contrast injection in the undrained segment.ObjectiveThe purpose of this study was to evaluate the results of unilateral metal stenting in type II and III malignant hilar biliary obstruction by using air as a contrast medium.DesignProspective, uncontrolled, single center pilot study.SettingTertiary care referral center.PatientsCohort of 17 patients with malignant hilar obstruction.InterventionA single metallic stent was inserted in type II and III malignant hilar obstruction by using air as a contrast medium. Patients were evaluated weekly up to 1 month after stent placement.Main Outcome MeasuresSuccessful implantation, successful drainage, early complications, procedure-related mortality, 30-day mortality.ResultSuccessful stent placement and drainage was achieved in 100% of the patients (17 of 17). No patient developed cholangitis or died within 30 days of the procedure.LimitationsSmall cohort of patients.ConclusionAir cholangiography provides a safe and effective roadmap for unilateral metallic stenting in type II and III malignant hilar biliary obstruction.