Frontiers of biliary endoscopy

The value of endoscopic retrograde cholangiography has been expanded recently by attention to technical detail and new methods for tissue diagnosis. Diagnostic information has been complemented by the new techniques of peroral choledochoscopy and endoscopic ultrasonography. The indications for endoscopic management of bile duct stones have become clearer, especially in patients with the gallbladder in situ. Techniques for distintegration and removal of large stones have improved. In patients with benign and malignant strictures recent emphasis has focused on the role of endoscopic management when compared with percutaneous and surgical approaches. Expandable metal stents are an interesting new option. The latest frontier is the gallbladder, which can now be reached with endoscopic catheters, and even directly with choledochoscopes through the papilla.