The Role of Choledochoscopy in Hepatopancreatobiliary Diseases

Abstract

Objective: Advances in choledochoscopy technology lead to an improvement in the diagnosis and treatment of hepatopancreatobiliary diseases. The aim of this study is to reveal the role of choledochoscopy in hepatopancreatobiliary pathologies. Materials and Methods:Choledochoscopy was used under general anesthesia in operation rooms. Flexible choledochoscope inserted via a vertical choledochotomy line, which was closed by primary closure, T-tube application, or choledochoduodenal anastomosis. Olympus CHF T 20 flexible choledochoscope and related endoscopic instruments were used for the procedures. The records were evaluated retrospectively. Results:This study presents the findings of 235 intraoperative choledochoscopy procedures. The most common indications were suspected common bile duct stone in 96 patients (40.9%), serum cholestatic enzyme increase without jaundice in 52 (22.1%), obstructive jaundice and/or serum bilirubin increase in 46 (19.6%), and presence of dilated choledoch in 42 (17.9%). Additional endoscopic diagnostic and/or therapeutic procedures were performed 156 times in 125 patients (53.2%), and endoscopic biliary stone removal was the most used procedure (87 patients, 37.0%). The mean choledochoscopy duration was 8.5 minutes (range: 5-25 minutes). Choledochoscopy confirmed preliminary diagnosis in 117 patients (49.8%), while different data were elicited in 68 (28.9%), and normal findings were found in 50 (21.3%). In this series, no choledochoscopy-related mortality was seen, and some complications occurred in 4 patients (1.7%). Conclusion:Intraoperative flexible choledochoscopy is a proper technique in the diagnosis and treatment of hepatopancreatobiliary disorders. Bulgular: Bu çalışmada 235 intraoperatif koledokoskopi işlemi sonuçları sunulmaktadır. En sık endikasyonlar 96 hastada (%40,9) koledok taşı şüphesi, 52'sinde (%22,1) sarılık olmaksızın serum kolestaz enzim yüksekliği, 46'sında (%19,6) tıkanma sarılığı ve/ veya serum bilirübin yüksekliği ve 42'sinde (%17,9) de geniş koledok varlığıydı. Ek endoskopik tanısal ve/veya terapötik işlemler 125 hastada (%53,2) 156 kez uygulandı ve safra taşı çıkarılması en sık kullanılan işlemdi (87 hasta, %37,0). Ortalama koledokoskopi süresi 8,5 dakikaydı (5-25 dakika arasında). Koledokoskopi 117 hastada (%49,8) ilk tanıyı doğrularken 68'inde (%28,9) farklı bulgular verdi, 50'sinde (%21,3) ise normal bulgular elde edildi. Bu seride koledokoskopi ile ilişkili ölüm görülmedi, 4 hastada (%1,7) bazı komplikasyonlar gelişti.Sonuç: İntraoperatif fleksibl koledokoskopi, hepatopankreatobiliyer hastalıkların tanı ve tedavisinde yararlı bir tekniktir.

The postoperative choledochoscopy in the management of the residual hepatolithiasis involving the caudate lobe

“…Hemobilia and infection are the most common complications, occurring in about 8% of cases. [ 18 ] In our study, 9 patients had complications (13.6%), which were fever and hemobilia, and relieved after conservative medical therapy. No severe complications and mortalities occurred.…”

“…Choledochoscopy plays a vital role in diagnosing and treating hepatopancreatobiliary diseases, involving removing the biliary system stones, biopsy or cytology for the diagnosis biliary tract malignancies, balloon dilatation of the biliary stricture, and stent implantation for bile duct tumor. [ 18 ] Meanwhile, postoperative choledochoscopy is an essential and effective method for residual hepatolithiasis. [ 11 ] The reported clearance rate of postoperative choledochoscopy for residual calculus in the intrahepatic duct ranges from 90% to 95.5%.…”

“…[ 11 ] The reported clearance rate of postoperative choledochoscopy for residual calculus in the intrahepatic duct ranges from 90% to 95.5%. [ 12 , 18 , 19 ]…”

“…It had been reported that the overall complications of cholangioscopy ranged from 18.28% to 32.73%. [ 18 , 22 ] Kong et al [ 12 ] reported that 986 patients with residual bile duct stones were performed with post-operative percutaneous choledochoscopy; 13 patients had complications, including perforated sinus, biliary peritonitis, sinus hypoplasia, bleeding, and intestinal fistular. Hemobilia and infection are the most common complications, occurring in about 8% of cases.…”

Coledocolitiasis y exploración laparoscópica de la vía biliar. Un estudio de cohorte

“…En algunas ocasiones se efectúa coledocoscopia a pacientes con estenosis de las anastomosis bilio digestivas, sometidos a procedimientos abiertos, y en quienes, durante la reintervención, los cirujanos hepatobiliares quieren estar seguros de que no queden cálculos proximales a la nueva anastomosis, lo que más tarde puede generar complicaciones e incluso colangitis, inflamación crónica o una nueva estenosis 43 .…”