Choledochoscopy? Post-exploratory fluorocholangiography? Or both?

Per-operative, post-exploratory fluorocholangiography and choledochoscopy were evaluated prospectively in 59 consecutive patients undergoing bile duct exploration for calculus disease. Fluorocholangiography showed filling defects in 13 cases and was valuable in localisation of stones, assessment of ampullary patency and visualisation of intrahepatic radicles. Choledochoscopy confirmed stones in nine cases, gave immediate confirmation of four false positive X-rays, enabled removal of five residual stones and biopsy of one benign stricture. This study suggests that fluorocholangiography should be performed routinely after duct exploration. Choledochoscopy is a useful adjunct but need only be performed in patients with abnormal X-ray findings; to confirm residual stones and aid in their removal or to permit biopsy of strictures.