Transfistula cholangioscopy: clarification of the diagnosis and antegrade removal of residual bile duct stones

Abstract

Aim. To demonstrate our own experience of performing transfistula cholangioscopy and removing bile duct stones.Materials and Methods. From 2017 to 2019, 230 patients with functioning external biliary drains underwent antegrade transfistula cholangioscopy. Preliminary dilatation and straightening of the fistulous tract were required in 37 patients.Results. Bile duct stones were detected in 158 (68.7%) patients. During transfistula cholangioscopy, stones were removed from all patients. In 68 cases with large choledocholithiasis, it was necessary to perform contact lithotripsy. To this end, staged treatment and two hospitalizations were required in five cases. Adequate transfistular access to the bile ducts was formed during the first hospital stay; during the second, after hardening of the access walls, the stones were removed. The overall complication rate was 3.8%, including grade III–IV complications (1.9%) according to the Clavien–Dindo classification. Mortality was 0.4%.Conclusion. Transfistula cholangioscopy increases the reliability of stone detection in the bile ducts, permits removing them without mandatory dissection of the major duodenal papilla, and creates favorable conditions for a more accurate assessment of its functional state. When patients with functioning biliary drains and unresolved bile duct diseases are placed in a specialized medical center, they can be provided with high-quality care. Additionally, it creates rational conditions for the use of the highly effective methods of endobiliary diagnosis and treatment.