Choledochoscopy in choledocholithiasis

Abstract

Abstract Stones are overlooked in the bile-ducts during operations for gall-stones sufficiently often to pose a continuing problem. The choledochoscope, first described 50 years ago, has recently been developed to a degree which makes it valuable in locating common-duct stones, besides permitting observation of changes in the ducts which are not otherwise demonstrable. At 37 duct explorations, among a total of 135 gallstone operations, endoscopy was found valuable in clarifying equivocal pre-exploratory cholangiograms, or on occasion taking their place, and in detecting stones not removed using the usual methods of detection. It is suggested that endoscopy is quicker and more readily repeatable than post-lithotomy cholangiography, is unaffected by bubbles entering the duct system, and avoids exposure of staff and patient to X-rays. However, it should be used in conjunction with pre-exploratory cholangiography.