Percutaneous cholangioscopy for management of retained biliary tract stones and intrahepatic stones

Over the last 13 years starting from 1975 when the first improved cholangiofiberscope was developed at the Teikyo University Hospital, 216 patients with retained biliary tract stones and 93 patients with intrahepatic stones have been seen; stone extraction was successful in 210 and 83 cases with percutaneous cholangioscopy, the success rate being 97.2 and 89.4% respectively. In particular, the advent of sophisticated technology for smashing stones, such as electrohydraulic lithotripsy, and cholangiofiberscope instrumentation have certainly helped to improve the therapeutic results in biliary tract stones. Today it can be claimed that visible stones are readily removable with percutaneous cholangioscopy. Moreover, percutaneous transhepatic cholangioscopy has been proved to be an indispensable tool for the management of intrahepatic stones and benign or malignant biliary tract diseases. Another advantage of percutaneous transhepatic cholangioscopy is that it may be indicated, even in patients in whom the transduodenal approach is considered too difficult to apply. The author firmly believes that even better therapeutic results can be expected if this endoscopic approach becomes more routine.