Multidisciplinary approach to complex endoscopic biliary intervention

Endoscopy is frequently used to treat biliary abnormalities; however, controlling the catheter is difficult when tortuous structures or specific intrahepatic ducts must be negotiated. Intraductal manipulation with conventional angiographic guidance is difficult, and combined transhepatic approaches are painful, associated with risk, and cumbersome. The authors describe a multidisciplinary approach to complex endoscopic procedures in which the interventional radiologist controls catheter and guide wire placement. Of 344 procedures attempted over a 3-year period, 304 were accomplished with transendoscopic- or fluoroscopic-guided methods alone. Combined transhepatic procedures were performed in the other 40 cases. The success rate of endoscopic procedures and the number of conditions treatable with nonoperative interventional methods are increased with a multidisciplinary approach.