Indications for cholangioscopy.
Cholangioscopy permits new diagnostic and therapeutic procedures. It can be performed via the peroral route when anatomical conditions are suitable. This procedure was attempted in 6 cases (lithiasis in 5, malignant stenosis in 1): cholangioscopy proved possible in 4 cases, and lithotripsy was successful in 2 cases out of 3. Percutaneous transhepatic cholangioscopy was performed when peroral cholangioscopy was not possible (non-accessible papilla, hepatico-jejunostomy), or failed. In 17 patients with common bile duct (CBD) stones, unextractable by conventional procedures 14 underwent a cholangioscopy with electrohydraulic lithotripsy. Sixteen had complete clearance of the CBD. Cholangioscopy was attempted in 18 patients with intra-hepatic lithiasis. Lithotripsy was necessary in 10 cases and stenosis dilatation in 8. Results were excellent in 15 patients, and good in 3 with diffuse intra-hepatic lithiasis. In the case of lithiasis, the complication rate of the procedure was 29.5% and 27.7% for CBD and intrahepatic stones, respectively, and the mortality rate was 8.5% (n = 3). These complications (bleeding and cholangitis) are closely related to the percutaneous route. In malignant stenosis (n = 5), cholangioscopy was performed for diagnostic purposes in one case, extraction of a stent in one case and endobiliary laser treatment in 3 cases.
Liguory
C L
CL
Centre Médico-Chirurgical de l'Alma, Paris.
Lefebvre
J F
JF
Bonnel
D
D
Cornud
F
F
Etienne
J P
JP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000175:diagnosis / Q000628:therapy*; D019723:Endoscopes; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D008096:Lithotripsy; D008875:Middle Aged