Methods, indications, and results of percutaneous choledochoscopy. A series of 161 procedures.

OBJECTIVE: Nonsurgical methods for evaluation and treatment of the biliary tree are usually done under fluoroscopic guidance. Direct visualization of the bile ducts, that is, choledochoscopy, could provide a more precise method with which to perform these maneuvers. The methods, indications, and results of percutaneous choledochoscopy are discussed from a series of 161 procedures performed in 123 consecutive patients. METHODS AND RESULTS: Ninety-six patients had transhepatic drains and 27 had T-tubes implanted. Biopsy of bile duct stenosis was conducted in 52 cases. The sensitivity for the diagnosis of malignancy was 78%, and the authors recommended this method in case of nonsurgical treatment of stenosis. Gallstone extraction was performed in 75 cases (35 intrahepatic). Lithotripsy was necessary for 64 patients and complete gallstone clearance was obtained for 69 patients (92%). The rate of stone recurrence was 18.1% (median follow-up, 32 months), prompting the authors to reconsider surgery for the treatment of underlying disease. Laser photocoagulation was used successfully for two of three patients to ablate an intraductal adenoma. In eight cases of cholangiocarcinoma, the laser effect was too short to satisfactorily relieve obstruction of the intrahepatic bile ducts. Morbidity dramatically decreased from 53.7% to 5% when progressive dilation of the tract, aseptic conditions, and general anesthesia were applied systematically. CONCLUSION: Percutaneous choledochoscopy can be used routinely, provided that strict techniques are adhered to. This procedure should be reserved for only a small subset of biliary diseases.

Endoscopic stenting for pain relief in chronic pancreatitis: results of a standardized protocol.

BACKGROUND: Pancreatic endoscopic stenting aims to relieve abdominal pain due to chronic pancreatitis. Optimal treatment modalities and post-treatment effects have still to be determined. The object of this study was to investigate the results of a standardized protocol of endoscopic stenting. METHODS: Twenty-three patients with abdominal pain due to chronic pancreatitis and stricture of the distal main pancreatic duct were treated according to the following protocol: after balloon dilation of the stenosis, a 10F stent was placed into the main pancreatic duct and then exchanged every 2 months, the total duration of drainage being 6 months. RESULTS: Use of analgesics could be discontinued in 17 patients (74%) on termination of drainage, and in 12 patients (52%) 1 year later. These results were significantly associated with reduction of main pancreatic duct diameter and resolution of stricture, but were not influenced by abstinence from alcohol and pancreatic enzyme supplementation. CONCLUSIONS: Pancreatic duct stenting results in short-term clinical improvement in patients with chronic pancreatitis and proximal main pancreatic duct stricture. Persistence of advantageous clinical results is to be expected in 50% of cases and when strictures have resolved.

[Fine-needle percutaneous transhepatic cholangiography. 84 cases]. / Cholangiographie percutanée transhépatique à l'aiguille fine. 84 cas

The authors report the results of 84 percutaneous transhepatic cholangiographies using a fine needle, describing the technique. Beyond the context of jaundice, failure of or inadequate opravenous cholangiography requires the use of other radiological techniques. By virtue of its simplicity, its usually good tolerance and its results, percutaneous transhepatic cholangiography has a place of choice in these indications. Its value in comparison with other non-surgical methods of direct opacification of the biliary tract is discussed.