Improved visualization of intrahepatic bile ducts by endoscopic retrograde balloon catheter cholangiography

In seven patients with a patulous sphincter of Oddi, choledochoduodenal fistula, previous sphincterotomy, sphincteroplasty or bilioenteric anastomosis in which standard endoscopic retrograde cholangiography (ERC) with a #5 French catheter failed to visualize intrahepatic ducts sufficiently due to a backflow of contrast into the duodenum, ERC was attempted via a balloon catheter to prevent escape of contrast. The results were compared with those using a #7 French catheter. In contrast to the latter, which gave only insufficient filling of hepatic ducts, the former permitted full visualization in all cases. Consequently, intrahepatic stones were demonstrated in three patients, and bile duct changes consistent with carcinoma in another. The absence of hepatic lesions was confirmed in the remaining three patients. No adverse reactions were experienced. It is concluded that the use of a balloon catheter constitutes an effective aid in ERC for the diagnosis of hepatic lesions in selected cases where conventional ERC fails.