[Percutaneous transhepatic cholangioscopy]

Percutaneous transhepatic cholangioscopy by means of small caliber endoscopes is a relatively safe and reliable technique and may be the optimal approach to the percutaneous evaluation and treatment of a variety of complex biliary tract processes. This technique combines the advantages of an endoscopic and a radiologic approach to the bile ducts. This procedure is rarely indicated to assess a biliary stenosis macroscopically and histologically because less invasive techniques have been developed to obtain histological material. The most frequent indication is the diagnosis, fragmentation and removal of bile duct stones. Small stones can be grasped and removed by means of Dormia-baskets. For the treatment of huge and impacted stones laser energy or electrohydraulic shock waves can be applied under endoscopic control. In selected cases of tumorous obstruction such as tumor ingrowth within implanted metallic stents, a tumor ablation can be performed using laser, electrocoagulation or injection of alcohol or cytostatic drugs.