[Spontaneous and iatrogenic choledochoduodenal fistula--endoscopic diagnosis and therapy]

A series of 17 cases of choledochoduodenal fistulas encountered in a 9.5-year-period (1978-1987) with 1140 endoscopic papillotomy (EPT) is presented (1.6%). The indications for duodenoscopy and endoscopic retrograde cholangiography (ERC) are cholestasis (78%), cholangitis (33%), upper abdominal pain (28%), jaundice (24%) and pancreatitis (17%). The choledochoduodenal fistulas are located on the longitudinal fold of the papilla (12 cases) and in the duodenal bulb (5 cases). Choledochoduodenal fistulas can easily be diagnosed by duodenoscopy with a side up view endoscope. As a method of direct cholangiography the ERC shows the relation of the fistula to the bile duct system. The preferred therapy of the choledochoduodenal fistula is the EPT combined with bile duct stone extraction.