[Peroral and transhepatic cholangioscopy]

Cholangioscopy is possible via the peroral or the transhepatic route. Cholangioscopy is of diagnostic value in tumour strictures and stenoses of the common bile duct. More important than diagnostic cholangioscopy is therapeutic cholangioscopy: with the technique of intracorporeal shockwave lithotripsy nearly all difficult CBD-stones may be successfully treated. 17 patients with 40 CBD-stones were managed in mother-babytechnique in applicating intraductal shockwaves under direct visual control (electrohydraulic principle). Mechanical lithotripsy during ERCP had formerly failed in all patients. In 6 patients transhepatic cholangioscopy with intracorporeal shockwave lithotripsy was successfully performed. Patients had an operated stomach, so conventional ERCP with lithotripsy was not possible. 18 stones could be treated. As a total 23 patients with 58 CBD-Stones underwent cholangioscopy (median stone diameter 20 mm) with intracorporeal shockwave lithotripsy. Complete stone clearance was achieved in all cases, no serious complication occurred.