الفهرس 
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Abstract
Further investigations with larger sample size and multicenter cooperation are needed to evaluate our findings.
• Ultrasound-guided PTBD was shown to be a safe and effective procedure for palliation of biliary obstruction in patients with malignant and benign biliary obstruction.
• Adjusting the initial puncture angle could be an additional valuable practical technique in reducing radiation dose without compromising the safety and efficacy of the PTBD procedure, with emphasis on its advantage in reducing complications.
• Accurate punctures of the targeted bile ducts were achieved in our study because ultrasound allowed visualization of the three- dimensional relationships between the bile ducts and surrounding tissues.
Summary and conclusion
Summary
Obstructive jaundice may be of malignant and benign etiologies. Carcinoma of the gall bladder, cholangiocarcinoma, pancreatic adenocarcinoma, metastasis, and lymph nodal compression of CBD constitute the majority of malignant causes.
Most of the patients with malignant obstructive jaundice are already advanced and inoperable by the time they are diagnosed, hence carry bad prognosis with palliation being the only option left. Obstruction needs to be drained even in such cases for reducing pain, cholangitis, anorexia and pruritus as well as to reduce the serum bilirubin levels in certain cases to initiate chemo or intrabiliary brachytherapy.
Over the years, palliation has evolved with the introduction of newer methods and improvisation of existing techniques. Recent palliative measures prolong longevity and improve the quality of life, hence increasing the acceptance to such procedures; Methods of biliary drainage include: a. Surgical bypass b. Minimally invasive procedures; ERCP, and PTBD.
ERCP as well as PTBD are well-established and effective means for biliary drainage as palliative treatment in unresectable cases.
With the current modern technique in experienced hands, PTBD equals ERCP regarding technical success and complications. In addition, there is a reduction in immediate procedure-related mortality with proven survival benefit. Moreover, it is the only immediate lifesaving procedure in cholangitis and sepsis.
The aim of this study was to evaluate the assist role and efficacy of ultrasound as a single tool for guidance of percutaneous transhepatic biliary drainage.
This prospective cohort study was to conducted on 50 patients with malignant obstructive jaundice. All patients were subjected to demographic data gathering, pre-operative preparation, and selection of appropriate target duct for biliary drainage.
Summary of Our Results:
• Bilirubin was significantly lower after percutaneous transhepatic biliary drainage compared to before the drainage (P value= 0.027).
• There was negative significant correlation between bilirubin after PTBD and residence (r= -0.313, P= 0.027), weight (r= - 0.390, P= 0.005), BMI (r= -0.325, P<0.001), cause of biliary disease (r=- 0.285, P=0.045) and PLT (r= -0.315, P=0.026).
• There was insignificant correlation between bilirubin after PTBD and age, sex, height, type of biliary disease, Hb, WBCs, prothrombin time, INR, BUN, creatinine, urea, and successful rate.
Conclusion
Ultrasound-guided PTBD is feasible, rapid, and effective method for relief of obstructive jaundice. PTBD is very effective as palliative method for neoplastic lesion and a bridging technique for benign biliary stricture,
The ultrasound guidance for PTBD was a safe, low cost, and effective technique for the management of obstructive biliary pathology with a successful rate 80% in the studied patients.