Narasimham L. Dasika MD, Presenter: Nothing to Disclose

We report indications, route of access, choice of instruments, technique, results and complications and follow up of 250 percutaneous choledochoscopy procedures in 150 patients  

Retrospective review of medical records of 150 consecutive patients subjected to percutaneous choledochosopy was performed. The indications, technique, choice of percutaneous access, instruments, results, complications and ancillary procedures performed were recorded. The influence of route of access, endoscope size, comorbidities, instruments, and ancillary procedures on outcome was analyzed.  

The indications are calculi located in 140 (intrahepatic 43, extrahepatic 57, gallbladder/cystic duct 9, and several ducts in 31), migrated stent in 3 and for recanalization of obstructed duct in 1, biopsy in a specific location in 2 and more than one indication in 4 patients. Access was through a PTC access in 102, cholecystostomy access in 15, surgical T-tube track in 16, and multiple accesses in others. Treatment was completed with one procedure in 113 patients, 2 in 23, 3 in 8, 4 in 2 patients.The reasons for repeat procedures are technical(N=8), bleeding(N=2), stone burden(N=16), missed calculi(N=10), comorbidities(N=1), and multiple reasons(N=10). During follow-up 7 patients had one, 4 had 2 and 1 patient had 5 recurrences of calculus disease. All the 3 encrusted stents were removed after fragmentation and removal of the calculi. EHL was used for fragmentation in 94, Treratola basket was used in 22 procedures to dislodge debris from wall. 73 ancillary procedures cholangioplasty (N=69) and endoscopic biopsy (N=4) were performed. The most common complication is fever and transient cholangitis in 30 patients. Multiple complications were noted in 4 patients. Peri procedural mortality from multiple causes is noted in 2 patients.  

Percutaneous choledochoscopy is an useful and safe procedure performed by the interventional radiologists to treat intra/extra hepatic biliary calculi, removal of foreign bodies, recanalization of chronically occluded ducts and in the treatment of complex biliary lesions including biopsy under vision. Multiple sessions may be required for treatment.  

The advantages of a safe and yet under utilized IR procedure that allows fragmentation of calculi, biopsy of a specific location, extraction of Foreign bodies under direct vision will be presented.

Dasika, N, Percutaneous Transhepatic Choledochoscopy in the IR Suite: Indications, Access, Technique, Ancillary Procedures, Results, Complications, and Follow-up of 250 Procedures.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8015931.html