The role of choledochoscopy in the diagnosis and management of biliary tract diseases

Background: The diagnosis and management of biliary tract disorders in cert ain cases may be incomplete without direct visualization of the bile ducts. Methods: We report our experience of 61 choledochoscopies (33 women, 27 men , mean age 44.6 years). Twenty patients had previously undergone orthotopic liver transplantation. All except two choledochoscopies were performed via the transpapillary route. Indications included suspected large bile duct s tones in 18 patients, anastomotic strictures in 16, abnormal cholangiograms in 5, elevated liver function tests in 7, suspected cholangiocarcinoma in 4, occluded biliary metallic stent in 4, hemobilia in 4, primary sclerosing cholangitis in 2 and ischemic bile duct injury in 1 patient. Results: Choledochoscopy confirmed the anticipated diagnosis in 36 of 61 (5 9%) patients. Importantly, it provided additional unsuspected diagnostic in formation in 18 of the 61 (29.5%) patients. In addition, for patients in wh om standard cholangiography was deemed abnormal, choledochoscopy demonstrat ed normal results in 7 (11.4%) patients. Fifty-two choledochoscopies were p erformed with therapeutic intentions, and the procedure was helpful in prov iding targeted treatment in 27 (44.2%) patients. Conclusions: Choledochoscopy is a safe and useful endoscopic modality that can provide specific diagnoses and direct treatment in various biliary trac t diseases. The additional information provided by choledochoscopy may chan ge overall patient management and outcome.