COMBINED TRANSHEPATIC AND ENDOSCOPIC PROCEDURES IN THE BILIARY SYSTEM

Endoscopic biliary procedures are 89-97% successful in skilled hands. The commonest causes of failure are inability to cannulate the papilla of Vater due to difficult anatomy or tortuosity of the distal common bile duct and failure to cross a rigid biliary stricture. In nearly al l of these cases, successful endoscopic procedures can be completed af ter percutaneous antegrade placement of a small catheter or guidewire to the duodenum. In 44 such combined procedures on 42 patients, the su ccess rate was 43 (98%). There were two severe and eight mild complica tions. Combined procedures overcome the difficulties caused by tortuou s biliary ducts and rigid strictures while obviating the need for more extensive percutaneous procedures and transhepatic tract dilatation,