Choledochoscopy of the cystic duct as a new approach to the biliary tree

Operative biliary endoscopy is traditionally performed through a common duct incision, through a very dilated cystic duct lumen. The development of the new ultra thin biliary scopes makes visual examination of the biliary tree possible through a normal cystic duct lumen. The operative approach to the gallbladder is unchanged. The indications for choledochoscopy of the cystic duct are the same as for operative cholangiogram. This examination can be of better quality and is less expensive than an operative roentgenogram. Unlike an operative cholangiogram, which at best visualized the bile ducts, the ultra thin scope gives the surgeon additional information concerning the ampulla of Vater, differentiating ductal spasm from stricture by its tactile feedback through the Bakes-like probe. When disease is present, it is possible for the scope to become a therapeutic instrument without the need for choledochotomy and its associated morbidity and cost. The high incidence of choledocholithiasis in this small series may be attributed to the sample size. It is also possible that more occult stones were found. If this is the case, most of these stones are being passed spontaneously and are never clinically apparent. It is those few patients who have small, occult stones that do not pass who benefit most from this new technology. This study was undertaken to develop and investigate the potential uses of a new biliary scope. These scopes require a learning period before the entire biliary tract can be visualized, but have the potential to be of significant value in the diagnosis and treatment of biliary tract disease.