Endoscopic appearance of the normal biliary system

Both rigid and flexible instruments can be used for endoscopic examination of the biliary tract. The approach is via the cystic duct or by means of a choledochotomy. The stump of the ductus cysticus will be useful if it is necessary to clarify a pathological finding in the distal bile duct or in the region of the papilla of Vater. Usually, however, the instrument is introduced by means of a choledochotomy. First of all, the distal region including the papilla of Vater and then the proximal part of the biliary system are closely examined. The normal biliary duct wall appears yellowish-red without showing the vascular structure. The papilla of Vater region presents a honeycomb appearance. Special emphasis in endoscopic examination is on papilla function, i.e. the opening or closing of the papilla if liquid is allowed to flow in. Results of 935 endoscopic examinations are reported.