METHODS, INDICATIONS, AND RESULTS OF PERCUTANEOUS CHOLEDOCHOSCOPY A SERIES OF 161 PROCEDURES

Objective Nonsurgical methods for evaluation and treatment of the bili ary tree are usually done under fluoroscopic guidance. Direct visualiz ation of the bile ducts, that is, choledochoscopy, could provide a mor e precise method with which to perform these maneuvers. The methods, i ndications, and results of percutaneous choledochoscopy are discussed from a series of 161 procedures performed in 123 consecutive patients. Methods and Results Ninety-six patients had transhepatic drains and 2 7 had T-tubes implanted. Biopsy of bile duct stenosis was conducted in 52 cases. The sensitivity for the diagnosis of malignancy was 78%, an d the authors recommended this method in case of nonsurgical treatment of stenosis. Gallstone extraction was performed in 75 cases (35 intra hepatic). Lithotripsy was necessary for 64 patients and complete galls tone clearance was obtained for 69 patients (92%). The rate of stone r ecurrence was 18.1% (median follow-up, 32 months), prompting the autho rs to reconsider surgery for the treatment of underlying disease. Lase r photocoagulation was used successfully for two of three patients to ablate an intraductal adenoma. In eight cases of cholangiocarcinoma, t he laser effect was too short to satisfactorily relieve obstruction of the intrahepatic bile ducts. Morbidity dramatically decreased from 53 .7% to 5% when progressive dilation of the tract, aseptic conditions, and general anesthesia were applied systematically. Conclusion Percuta neous choledochoscopy can be used routinely, provided that strict tech niques are adhered to. This procedure should be reserved for only a sm all subset of biliary diseases.