Direct Cholangioscopy

 

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Objectives and Basic Principles

Since it was first advocated by Takada et al. in 1974 [1], percutaneous transhepatic cholangioscopy (PTCS) has been utilized to manage a variety of biliary tract disorders. Percutaneous lithotomy using PTCS has become one of the most important nonsurgical forms of treatment for hepatolithiasis. The diagnostic and therapeutic efficacy of PTCS has been widely accepted, and clinical applications for this procedure have expanded to provide more precise preoperative diagnosis of biliary malignancy and to treat difficult biliary stenoses or gallstones using improved and less invasive instruments. PTCS has also been used in the management of diverse biliary tract disorders, including biliary neoplasms, calculi, strictures (benign and malignant), and evaluation of biliary-enteric anastomoses. PTCS appears to be of particular benefit in managing poor surgical candidates with diffuse intrahepatic stones.

Nonsurgical cholangioscopy has been established for the peroral or the percutaneous route, to be used via a T-tube tract or a transhepatic fistula. Although cholangioscopy has played a significant role in the preoperative diagnosis and nonsurgical treatment of biliary diseases, there have been few technical improvements in the procedure for several years. Although recently developed miniature endoscopes and appropriate video converters allow a minimally invasive approach to the biliary system, the popularity of the procedure is still limited due to the small spectrum of suitable indications and the required endoscopic expertise.

Publication History

Publication Date:
20 August 2003 (online)

© 2003. Thieme. All rights reserved.

Georg Thieme Verlag Stuttgart · New York
Stuttgart

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