A critical assessment of fluoroscopy in peroperative cholangiography.

In a prospective study of 248 patients undergoing peroperative cholangiography fluoroscopy improved the quality of radiographs by ensuring the use of a volume of contrast medium appropriate to each patient's duct capacity and the correct positioning of the ducts away from obscuring objects. Failure of contrast medium to enter the duodenum is usually considered to be an indication for choledochotomy. Although this occurred in 35 patients, the use of fluoroscopy and the injection of an anticholinergic drug without further contrast medium showed the choledochoduodenal junction to be normal, making choledochotomy unnecessary, in 28. The low negative duct exploration rate (3 of 56 patients) and the virtual elimination of false positive peroperative postexploratory cholangiograms (1 of 50 patients) provide further evidence of the value of fluoroscopy.