Percutaneous choledochoscopy and cholecystoscopy: diagnostic and therapeutic uses

Accessibility to the common bile duct and gallbladder through sinus tracts formed after placement of a T-tube or cholecystostomy tube at surgery has until recently been restricted to special catheters and accessories for the extraction of stones. The procedure requires continuous fluoroscopy while contrast media is injected in order to identify defects and to place accessories. More recently this techniques has been accomplished with endoscopes which are advanced into the bile duct through these tracts. The results are comparable to the catheter technique but exposure to x-ray is reduced. The procedure has been performed with a bronchoscope (BF-4B2-Olympus Corporation of America), modified with an irrigation-suction valve, permitting direct examination, biopsy and entrapment of stones. With the bronchoscope in the bile duct, physiologic function and pathologic conditions can be assessed by advancing catheters through the ampulla into the duodenum, 1) the former to facilitate manometric recordings and, 2) the latter to calibrate the opening of the papilla. A catheter passed antegrade through the bronchoscope into the duodenum can be used as a guide for the simultaneous performance of sphincterotomy while the duodenoscope is in position. These new applications have placed choledochoscopy and cholecystoscopy in the armamentarium for the evaluation and treatment of biliary tract disease.