Endoscopy as an adjuvant to biliary radiologic intervention

Twenty-two patients underwent 24 percutaneous biliary procedures guided with choledochoscopy, an adjunctive percutaneous biliary technique. All but four procedures were performed through established percutaneous tracts; the others, through tracts less than 4 weeks old. The procedures were done for the following reasons: removal of calculi (n = 15), electrohydraulic lithotripsy (n = 1), biliary duct biopsies (n = 8), cauterization of a bleeding tract (n = 1), and evaluation of biliary-enteric anastomoses (n = 11). The only complication was one case of severe nausea after choledochoscopy. This patient required overnight hospitalization and medical treatment. All procedures were technically successful, except one case in which the tract was undersized. All patients received intravenously administered antibiotics before and after the procedure. It is concluded that choledochoscopy is a safe, atraumatic, and well-tolerated method of evaluating and treating biliary disease and that it markedly reduces radiation exposure. It can be performed rapidly with minimal sedation on an in- or outpatient basis.