The role of choledochoscopy in the diagnosis and management of biliary tract diseases

Siddique, Iqbal; Galati, Joseph; Ankoma‐Sey, Victor; Wood, Robert; Ozaki, Claire F.; Monsour, Howard Paul; Raijman, Isaac

doi:10.1016/s0016-5107(99)70347-0

Cited by 106 publications

(75 citation statements)

References 9 publications

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“…Although cholestasis, with or without jaundice, is one of the major indications of MRCP or ERCP, intraoperative choledochoscopy is an alternative diagnostic and therapeutic method, particularly in patients in whom MRCP or ERCP is not performed, inadequate, or unsuccessful [3,[6][7][8], as was in our study. Choledoch stones, as well as the residual biliary stones, are the most important factors that affect the cost effectivity, mortality, and morbidity in patients with biliary system stones, which are benign diseases [3,13,14].…”

Section: Discussionmentioning

confidence: 79%

“…Choledoch stones, as well as the residual biliary stones, are the most important factors that affect the cost effectivity, mortality, and morbidity in patients with biliary system stones, which are benign diseases [3,13,14]. MRCP and ERCP have some restrictions; MRCP is not a therapeutic procedure in addition to its 28% of false negativity and 11% of false positivity diagnostic rates for biliary system stones [3,[6][7][8], while ERCP is an invasive procedure, even if minimal, with a mean 15% of complication rate in addition to its 5-20% of impossible cannulation rate [3,15]. Additionally, to palpate or to determine the choledoch stones during laparoscopic surgery is difficult, even if possible, so it is important to diagnose them before surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, electrohidrolic or laser lithotripsy can be performed by this technique [3,18,[21][22][23][24][25][26][27]. On the other hand, some other major application areas of choledochoscopy are biopsy or cytology for the diagnosis of biliary tract malignencies, intrabiliary rupture of hydatid cysts, balloon dilatation of the biliary tract, electrocoagulation, or stent application for biliary malignencies [3,6,7,11,12,14,16,17,26,[28][29][30][31][32][33], similar to our study.…”

Section: Discussionmentioning

confidence: 99%

“…Technology was started to scan gastrointestinal system, and than choledoch, one of the narrowest channels of the body, was visualised by the endoscopes. After the first experience of Kawai et al [4] in optic system and mobilisation capability of the endoscopes made the choledochoscopy as valuable method in the diagnosis and treatment of hepatopancreatobiliary system diseases [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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The Role of Choledochoscopy in Hepatopancreatobiliary Diseases

et al. 2016

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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.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Role of Choledochoscopy in Hepatopancreatobiliary Diseases

et al. 2016

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“…Choledo-choscopy may be a direct diagnostic procedure to help in macroscopically assessing inconclusive lesions inside the biliary duct system. However, technical means were limited so far as the "mother-baby" system had to be operated by two interventionalists, while confirming the results of malignity-suspicious findings remained a true histological challenge [3][4][5] . Technical restrictions of the above mentioned procedures may explain the insufficient sensitivity of diagnostics when it comes to biliary changes [6] .…”

Section: Introductionmentioning

confidence: 99%

Single operator choledochoscopy and its role in daily endoscopy routine

Hoffman¹

2013

WJGE

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Different diagnostic procedures exist for the detection of bile duct lesions in clinical practice. However, neither retrograde contrast imaging of the bile duct endoscopic retrograde cholangiopancreatogram nor other imaging procedures allow a safe diagnosis of the lesions. Therefore choledochoscopy may be a useful diagnostic procedure in macroscopic assessing lesions of the bile duct. Even if the diagnostic sensitivity and specificity is not sufficient, first studies suggest an enhanced diagnostic accuracy for choledochoscopy. Since the progress of choledochoscopy has started in the 1970 different improvements were achieved. Meanwhile, the examination can be performed by an examiner and samples can be taken. Image and Resolution quality has improved over the past years, also. The SpyGlass system is a technically advanced cholangioscopic device to provide endoscopic diagnosis in case of inconclusive bile duct findings. Further more, two more lumina allow specific biopsy forceps and optical fibers for electrohydraulic or laser lithotripsy. The most frequent useful insert of SpyGlass in clinical practice are in complex gallstones and bile duct lesions of unclear dignity.

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The Role of ERCP in Pancreatico‐Biliary Malignancies

Parasher¹,

Lee²

2005

Advanced Digestive Endoscopy: ERCP

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The role of choledochoscopy in the diagnosis and management of biliary tract diseases

Cited by 106 publications

References 9 publications

The Role of Choledochoscopy in Hepatopancreatobiliary Diseases

The Role of Choledochoscopy in Hepatopancreatobiliary Diseases

Single operator choledochoscopy and its role in daily endoscopy routine

The Role of ERCP in Pancreatico‐Biliary Malignancies

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