Endoscopic retrograde cholangioscopy. An adjunct to endoscopic exploration of the common bile duct

Choledochoscopy is an accepted technique in the operative exploration of the common bile duct, and is complimentary to operative cholangiography. Retrograde cholangiography can be achieved perorally in up to 97 per cent of patients and it is reasonable to assume that the use of complimentary cholangioscopy in such patients would help to improve the accuracy of bile duct examination just as it does when applied in the operative setting. We have had the opportunity to use a new technology in the endoscopic evaluation of the common bile duct. An endoscopic retrograde cholangioscopy (ERCP) is first performed and ductal anatomy outlined. When indicated, an endoscopic sphincterotomy is performed. If large stones are present they are removed with a balloon or basket. The standard side-viewing endoscope is then removed and replaced with the large channel, side-viewing scope. A "baby" scope is introduced through the "mother" scope and canulation of the common duct with the "baby" scope is performed. Biopsies and brushings of lesions may be obtained and numerous instruments are available for manipulation through the biopsy channel of the "baby" scope. The use of retrograde cholangioscopy as an adjunct to retrograde cholangiography should provide the same advantages that have been demonstrated with the use of operative choledochoscopy. Use of this instrument will allow the endoscopist to accurately identify questionable lesions seen on the cholangiogram, selectively canulate particular biliary radicals, biopsy lesions of the common duct, and perhaps intervene therapeutically in selected biliary tract lesions.