Endoscopy 2014; 46(01): 16-21
DOI: 10.1055/s-0033-1359043
Original article
© Georg Thieme Verlag KG Stuttgart · New York

A multicenter study on the role of direct retrograde cholangioscopy in patients with inconclusive endoscopic retrograde cholangiography

Harald Farnik
1  Medizinische Klinik I, Johann Wolfgang Goethe-Universität, Frankfurt, Germany
,
Jochen Weigt
2  Klinik für Gastroenterologie, Hepatologie und Infektiologie, Otto-von-Guericke-Universität, Magdeburg, Germany
,
Peter Malfertheiner
2  Klinik für Gastroenterologie, Hepatologie und Infektiologie, Otto-von-Guericke-Universität, Magdeburg, Germany
,
Angela Grützmann
3  Medizinische Klinik II, Klinikum Karlsruhe, Karlsruhe, Germany
,
Liebwin Gossner
3  Medizinische Klinik II, Klinikum Karlsruhe, Karlsruhe, Germany
,
Mireen Friedrich-Rust
1  Medizinische Klinik I, Johann Wolfgang Goethe-Universität, Frankfurt, Germany
,
Stefan Zeuzem
1  Medizinische Klinik I, Johann Wolfgang Goethe-Universität, Frankfurt, Germany
,
Christoph Sarrazin
1  Medizinische Klinik I, Johann Wolfgang Goethe-Universität, Frankfurt, Germany
,
Jörg G. Albert
1  Medizinische Klinik I, Johann Wolfgang Goethe-Universität, Frankfurt, Germany
› Author Affiliations
Further Information

Publication History

submitted 19 June 2013

accepted after revision 30 October 2013

Publication Date:
18 December 2013 (online)

Background and study aims: Direct retrograde cholangioscopy (DRC) may improve the diagnostic and therapeutic yield of endoscopic retrograde cholangiography (ERC) but safety, feasibility, and outcome are unknown.

Patients and methods: All consecutive patients who underwent DRC at three tertiary endoscopy centers for inconclusive findings at ERC were included in this retrospective analysis. Ultraslim endoscopes (FujiFilm EG 530NP; Olympus GIF XP180; GIF N180) were used by the peroral route for intubating all accessible bile ducts. Success rate, usefulness in diagnosis and therapy, and safety of DRC were assessed in terms of technical and clinical parameters and therapeutic vs. diagnostic indication.

Results: DRC was performed in 130 cases (89 patients). CO2 insufflation and an anchoring balloon were used in 66.9 % and 97.7 % of cases, respectively. Intubation of the papilla was successful in 115 of 130 (88.5 %) cases, and the aim of the DRC investigation was accomplished in 105 cases (80.8 %). DRC-guided biopsies were taken in 53 cases (40.8 %), and a therapeutic intervention was performed in 32 cases (24.6 %). The initial diagnosis was revised by DRC in 18 of 69 patients (26.1 %) with indeterminate biliary stricture. Complications were observed in 10 cases (7.7 %), including cholangitis (n = 2; 1.5 %), bleeding (n = 2; 1.5 %), and pain, hypoxia, bradyarrhythmia, air embolism, and perforation of an intrahepatic and an extrahepatic bile duct (1 each; 0.8 %). There was no mortality associated with DRC.

Conclusions: DRC was successfully performed for the diagnosis and treatment of biliary disease that had eluded diagnosis with conventional ERC. DRC impacted on clinical decision making. The complication rate was low and similar to other cholangioscopy techniques.