[Percutaneous and trans-papillary cholangioscopy: current diagnostic and therapeutic possibilities]

Peroral and transhepatic cholangioscopy represent a substantial enrichment of the diagnostic and therapeutic spectrum in gastroenterology. The use of cholangioscopy in the diagnostics of hepato-biliary disease seems to make especially sense in those cases where ERCP, sonography and CT do not lead to a sufficient clarification of the pathological findings and inspection, biopsy and cytology are required. An essential field of application for cholangioscopy consists today in the lithotripsy of giant common bile duct stones where laser lithotripsy means an important progress in the complication-free removal of these concrements. Percutaneous-transhepatic cholangioscopy as the more invasive procedure is especially indicated in those cases where due to former operations or special anatomical situations the endoscopic retrograde access is difficult or impossible. Further fields of application like endoluminal ultrasound via miniaturized probes or photodynamic diagnostics and photodynamic therapy (PDT) of cholangiocarcinoma seem to be valuable aims for the future.