Serology to detect antibodies to Helicobacter pylori is not frequently used as a diagnostic tool in developing countries. When compared to a commercial ELISA, an ELISA constructed and validated in Thailand had a higher sensitivity (98% vs. 85%), specificity (76% vs. 66%), and negative predictive value (97% vs. 76%) for the detection of H. pylori infection among 104 patients with dyspepsia evaluated by endoscopy. The positive predictive value was 88% for both tests. Serum antibody levels fell significantly 5-8 months after eradication of infection in 8 Thai patients (P = .009). By 8 years of age, > 50% of Thai persons living in urban and rural locations were seropositive. The low negative predictive value of the commercial ELISA limits the usefulness of this assay as a diagnostic tool in Thailand and suggests a need to reevaluate H. pylori serologic tests when used in populations living in developing countries.

In a prospective study, 276 consecutive patients were evaluated using percutaneous transhepatic cholangiography (PTC) with a Chiba needle prior to surgery for cholestasis. Biliary calculi were diagnosed in 109 patients. The success rate was 92.4% overall, 93.6% among patients with biliary calculi, 83.3% in those with cholelithiasis, 97.3% in those with choledocholithiasis, and 100.0% in those with intrahepatic stones. The overall morbidity rate was 4.6%, including hemoperitoneum in 1.8% and bile leakage in 2.8%. There were no deaths. This technique offers a more definitive diagnosis than noninvasive procedures, especially with small calculi, but is also more traumatic. PTC may play an important role when noninvasive methods are inconclusive or in difficult cases, particularly following surgery on the common bile duct.

FIGURE 1. -Case 1. A 40-year-old male. X-ray Diagnosis: The tip of the needle is in one of many cystic dilatations of the intrahepatic ducts. Filling by contrast material occurred only on the right side showing narrowing and irregularity of right intrahepatic ducts. The common hepatic duct, common bile duct and gall bladder are normal. This represents parasitic (opisthorchiasis) dilatation of intrahepatic ducts. Definite Diagnosis: Cholangiocarcinoma.

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