title: A multicenter study on the role of direct retrograde cholangioscopy in patients with inconclusive endoscopic retrograde cholangiography.
abstract: OBJECTIVE
  Direct retrograde cholangioscopy (DRC) may improve the diagnostic and therapeutic yield of endoscopic retrograde cholangiography (ERC) but safety, feasibility, and outcome are unknown.
  
  
  METHODS
  All consecutive patients who underwent DRC at three tertiary endoscopy centers for inconclusive findings at ERC were included in this retrospective analysis. Ultraslim endoscopes (FujiFilm EG 530NP; Olympus GIF XP180; GIF N180) were used by the peroral route for intubating all accessible bile ducts. Success rate, usefulness in diagnosis and therapy, and safety of DRC were assessed in terms of technical and clinical parameters and therapeutic vs. diagnostic indication.
  
  
  RESULTS
  DRC was performed in 130 cases (89 patients). CO2 insufflation and an anchoring balloon were used in 66.9% and 97.7% of cases, respectively. Intubation of the papilla was successful in 115 of 130 (88.5%) cases, and the aim of the DRC investigation was accomplished in 105 cases (80.8%). DRC-guided biopsies were taken in 53 cases (40.8%), and a therapeutic intervention was performed in 32 cases (24.6%). The initial diagnosis was revised by DRC in 18 of 69 patients (26.1%) with indeterminate biliary stricture. Complications were observed in 10 cases (7.7%), including cholangitis (n=2; 1.5%), bleeding (n=2; 1.5%), and pain, hypoxia, bradyarrhythmia, air embolism, and perforation of an intrahepatic and an extrahepatic bile duct (1 each; 0.8%). There was no mortality associated with DRC.
  
  
  CONCLUSIONS
  DRC was successfully performed for the diagnosis and treatment of biliary disease that had eluded diagnosis with conventional ERC. DRC impacted on clinical decision making. The complication rate was low and similar to other cholangioscopy techniques.
authors.affiliation: Medizinische Klinik I, Johann Wolfgang Goethe-Universität, Frankfurt, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Farnik
authors.affiliation: Klinik für Gastroenterologie, Hepatologie und Infektiologie, Otto-von-Guericke-Universität, Magdeburg, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Weigt
authors.affiliation: Klinik für Gastroenterologie, Hepatologie und Infektiologie, Otto-von-Guericke-Universität, Magdeburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Malfertheiner
authors.affiliation: Medizinische Klinik II, Klinikum Karlsruhe, Karlsruhe, Germany.
authors.forename: Angela
authors.initials: A
authors.lastname: Grützmann
authors.affiliation: Medizinische Klinik II, Klinikum Karlsruhe, Karlsruhe, Germany.
authors.forename: Liebwin
authors.initials: L
authors.lastname: Gossner
authors.affiliation: Medizinische Klinik I, Johann Wolfgang Goethe-Universität, Frankfurt, Germany.
authors.forename: Mireen
authors.initials: M
authors.lastname: Friedrich-Rust
authors.affiliation: Medizinische Klinik I, Johann Wolfgang Goethe-Universität, Frankfurt, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Zeuzem
authors.affiliation: Medizinische Klinik I, Johann Wolfgang Goethe-Universität, Frankfurt, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Sarrazin
authors.affiliation: Medizinische Klinik I, Johann Wolfgang Goethe-Universität, Frankfurt, Germany.
authors.forename: Jörg G
authors.initials: JG
authors.lastname: Albert
mesh_terms: D000368:Aged; D014670:Ampulla of Vater; D001660:Biliary Tract Diseases / Q000175:diagnosis* / Q000628:therapy*; D002404:Catheterization; D002758:Cholangiography; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007327:Insufflation / Q000379:methods; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies