[Peroral and percutaneous transhepatic cholangioscopy]

Cholangioscopy, in conjunction with histological examinations, yields diagnostic information in unclear biliary diseases in addition to conventional indirect imaging methods. Unclear stenoses and protruded lesions can be differentiated, and the preoperative staging can probably be improved due to an exact mapping of the intraductal extension of bile duct lesions. Cholangioscopic electrohydraulic lithotripsy or laser treatment of stones not amenable to routine endoscopy are highly effective and safe alternatives to surgery. The peroral technique promises a rapid visualization of the biliary tree, provided that the papilla can be approached adequately. The retrograde access to lesions above the bifurcation or upstream from strictures is limited. In contrast, the more time-consuming percutaneous transhepatic cholangioscopy can be performed even in patients with a difficult anatomy, retrogradely inaccessible bile duct stenoses or intrahepatic calculi. However, this approach should be limited to cases not amenable to peroral techniques, because the creation of the cutaneo-biliary fistula is not without risks.