[Possibilities of endoscopy in bile duct lesions]

Biliary duct injuries are occasional complications of cholecystectomy, encountered especially during early experience of laparoscopic cholecystectomy. Beside surgical reintervention, several promising endoscopic therapeutic procedures are available. Endoscopic papillotomy, possibly in combination with the placement of a drain, brings about occlusion of biliary leakage and fistula in 80% of cases. Strictures and stenoses of biliodigestive anastomoses can be treated using endoscopic transpapillary or, additionally, transhepatic percutaneous techniques. The results are comparable to those of surgery with lower rates of complications. For final judgement, however, a longer period of observation is necessary. At the moment non-surgical procedures are to be considered for patients at high risk from surgery and patients with recurrent stenoses after surgical interventions. Management of choledocholithiasis, complicating cholecystolithiasis, is becoming more and more a task for the endoscopist, at least at the present stage of evolution of laparoscopic cholecystectomy. Endoscopic bile duct clearance with or without percutaneous clearance, if necessary in combination with modern techniques of lithotripsy, is successful in almost all cases. However, the indications for risky and time-consuming procedures should always be discussed between surgeons and internists.