H. Joachim Burhenne Lecture. Common areas of interest between interventional biliary radiology and endoscopy

Therapeutic biliary endoscopy is a more recent subspecialty than interventional biliary radiology, and much has been learned from the pioneering work of interventional radiologists. The areas of interest to biliary radiologists and biliary endoscopists are largely identical. The common bile duct can be approached either by the antegrade percutaneous transhepatic approach or by the retrograde endoscopic transpapillary route. In most cases, endoscopy is the treatment of choice because of its lower risk. A new era in therapeutic endoscopy began with the invention of endoscopic papillotomy in 1973 by Classen and Demling in Germany [1] and Kawai et al. in Japan [2]. This technique made access to the hepatobiliary and pancreatic ductal systems possible, and endoscopic papillotomy has replaced choledochotomy for the treatment of bile duct stones in many centers. Endoscopic or radiologic treatment can entirely replace surgical management. The radiologic approach is advantageous via the endoscopic route when a patient has residual stones in a T tube or intrahepatic stones that lie proximal to a stricture. For patients who have had abdominal surgery and in whom access to the papilla is sometimes impossible because of a long afferent jejunal loop, radiologic therapy is suitable. They also can be treated by the rendezvous approach, whereby the radiologist feeds a guidewire through the papilla into the duodenum and the endoscopist then accesses the bile duct in a retrograde fashion. Calculous disease and ductal stenoses are the main indications for endoscopic therapy; these and other conditions of the biliary tract will be discussed here.