[Pancreaticoscopy: experiences, possibilities and limits]. / Pankreatikoskopie: Erfahrungen, Möglichkeiten und Grenzen.

Cholangioscopy in the mother-baby technique is well accepted and widespread these days. On the other hand, the peroral pancreaticoscopy (POPS) is still in the initial phase of development. In cases of doubtful stenoses, duct discontinuation, and radiolucent shadows during an endoscopic retrograde cholangiopancreatography (ERCP) the POPS can be carried out as a clarifying examination. Two variations of babyscopes are currently available. The ultra-thin endoscope allows only limited results due to the lack of tip control and irrigation. On the other hand, devices with an outer diameter of 3.2 mm and larger provide for a sufficient assessment of the duct mucosa. Biopsies can be taken through the working channel, and the probes for intracorporeal shock wave lithotripsy (ISWL) can be placed under visual control. We performed POPS on 9 patients with an average age of 60 years using a tip-controlled endoscope. In 8 of these cases a diagnostic or therapeutic advantage was gained. A 29-year old patient with alcohol-induced chronic pancreatitis and an occluding duct stone underwent electrohydraulic lithotrips (EHL). A 60-year-old patient with pancreatic duct stones underwent laser-induced shock wave lithotripsy (LISL) in 2 sessions. Afterwards remaining parts of the calculi were extracted. The importance of this method in diagnosis and therapy of pancreatic diseases remains to be established, as evaluation studies of any great extent are still to be done.

[Angioimmunoblastic lymphadenopathy with dysproteinemia and sclerosing cholangitis]. / Angioimmunoblastische Lymphadenopathie mit Dysproteinämie und sklerosierender Cholangitis.

A 28-year-old man with recurrent swelling of both upper eyelids was found to have increased values in several liver function tests (GOT 162 U/l, GPT 356 U/l, gamma-GT 643 U/l, bilirubin 3.0 mg/dl, alkaline phosphatase 925 U/l). Abdominal ultrasonography demonstrated lymph node enlargements up to 3 cm, dilated intra- and extrahepatic bile ducts, as well as a cyst of 3 cm size in the pancreatic tail. Endoscopic retrograde cholangiopancreatography and punch biopsy of the liver revealed sclerosing cholangitis. In addition to the eyelid swellings the patient also had protrusion of the left eyeball, blood eosinophilia (800/microliter) and marked increase in polyclonal IgG (6930 mg/dl) with lymphadenopathy suggesting the diagnosis of angioimmunoblastic lymphadenopathy with dysproteinaemia (AILD, lymphogranulomatosis X), confirmed by lymphocyte surface marker analysis. However, histological examination of a lymph node was more suggestive of a T-zone lymphoma. Treatment with ursodeoxycholic acid (250 mg three times daily) and prednisolone (initially 2 mg/kg daily) quickly led to normal biochemical values and regression of the eye changes. In addition, treatment with interferon alpha-2b (initially 3 mill. U daily for 10 days) was begun. The abnormalities in the bile ducts disappeared 6 months later. The patient has been in full remission for 25 months (prednisolone dosage reduced to 12.5/7.5 mg alternating daily and interferon alpha-2b 3 mill. U three times weekly). This response makes AILD with secondary involvement of the bile ducts the most likely diagnosis.

[Percutaneous transhepatic cholangioscopy as a single-step technique]. / Percutan-transhepatische Cholangioskopie in Einschritt-Technik.

The PTCS is a method for diagnostic and therapeutic purpose in patients with common bile duct diseases not suitable for transpapillary approach. The present paper describes a technique which shortens the usual time of treatment and reduces injury. Lithotripsy of common bile duct stones, endoscopic controlled biopsy, introduction and removal of bile duct endoprosthesis as well as percutaneous papillotomy is possible.

[Peroral and transhepatic cholangioscopy]. / Perorale und transhepatische Cholangioskopie.

Cholangioscopy is possible via the peroral or the transhepatic route. Cholangioscopy is of diagnostic value in tumour strictures and stenoses of the common bile duct. More important than diagnostic cholangioscopy is therapeutic cholangioscopy: with the technique of intracorporeal shockwave lithotripsy nearly all difficult CBD-stones may be successfully treated. 17 patients with 40 CBD-stones were managed in mother-babytechnique in applicating intraductal shockwaves under direct visual control (electrohydraulic principle). Mechanical lithotripsy during ERCP had formerly failed in all patients. In 6 patients transhepatic cholangioscopy with intracorporeal shockwave lithotripsy was successfully performed. Patients had an operated stomach, so conventional ERCP with lithotripsy was not possible. 18 stones could be treated. As a total 23 patients with 58 CBD-Stones underwent cholangioscopy (median stone diameter 20 mm) with intracorporeal shockwave lithotripsy. Complete stone clearance was achieved in all cases, no serious complication occurred.