Incidence of complications with operative choledochoscopy.

A 5 year retrospective study of the use of cholangioscopy in 153 difficult biliary cases including stones, strictures, tumors, and anomalies has been reported. In the 88 patients (58 percent) who underwent both operative cholangiography and cholangioscopy, the cholangioscope revealed 11 lesions (13 percent) missed by cholangiography. In this series, eight retained stones (5.2 percent) were detected on postoperative T-tube cholangiography; of this group, two patients had previous biliary surgery, two had an associated neoplasm, and four had incomplete cholangioscopy for various reasons. Postoperative complications included transient bile drainage (8 percent), pancreatitis (8 percent), persistent jaundice (7 percent), cholangitis (5 percent), and abscess (5 percent). Comparison of an operative cholangiography-only group with a cholangioscopy-only group revealed no significant difference in the incidence of postoperative complications. Cholangioscopy did not increase postoperative complications in this study. It frequently detected lesions missed by cholangiography and helped define the nature of the lesions. The incidence of retained stones may be reduced by use of the cholangioscope in difficult biliary cases. Its routine use in common bile duct exploration is recommended.