Choledochoscopy as a complementary procedure to operative cholangiography in biliary surgery

Area of Science:

• Gastroenterology and Hepatobiliary Surgery

Background:

• Common bile duct exploration is crucial for diagnosing and treating choledocholithiasis.
• Operative cholangiography is a standard imaging technique but can yield equivocal results.

Purpose of the Study:

• To evaluate the utility of flexible choledochoscopy as a complementary tool during common bile duct exploration.
• To assess the impact of choledochoscopy on the accuracy of stone detection and the incidence of retained stones.

Main Methods:

• A retrospective review of 149 patients undergoing common bile duct exploration with choledochoscopy over six years.
• Choledochoscopy was used to clarify uncertain cholangiogram findings and guide stone extraction.

Main Results:

• Choledochoscopy confirmed the absence of stones in 37 patients with suspicious cholangiograms.
• In 112 patients, choledocholithotomy with choledochoscopy resulted in only two (1.3%) with residual stones.
• Direct visualization facilitated accurate diagnosis and effective stone removal.

Conclusions:

• Flexible choledochoscopy enhances the accuracy of common bile duct exploration by clarifying ambiguous cholangiographic findings.
• Its use as an adjunct to operative cholangiography minimizes blind exploration and reduces retained stone rates.