Diagnosis of Benign Biliary Tract Diseases by ERCP: Improvement of Its Diagnostic Ability with the Use of an Indwelling Balloon Catheter S. Ikeda 1 , H. Yoshimoto 1 , M. Tanaka 1 , H. Itoh 1 1The First Department of Surgery, Faculty of Medicine, Kyushu Univirsity pp.1095-1105
Published Date 1982/10/25
DOI https://doi.org/10.11477/mf.1403108753
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 Even in our present state of established techniques and improved equipments of ERCP, we not infrequently face a difficulty in making a diagnosis of intrahepatic lesions if sufficient filling of intrahepatic bile ducts cannot be obtained due to various conditions (Table 1). Forty-four such patients (Table 2) were investigated using a balloon catheter to block a backflow of contrast medium injected and fill the bile duct under pressure. In an early phase of the study, cholangiograms were obtained with the duodenoscope in place; more recently, the scope was removed leaving the balloon catheter in the bile duct to reduce the patient's discomfort and facilitate posture changes (Fig. 2). “Standard” cholangiograms were taken in the head-down prone position at the first notice of the backflow of contrast medium before inflation of the balloon in all individuals, and compared with films obtained under pressure by the balloon method. The “standard” films gave a definite diagnosis of intrahepatic stones in only one patient, whereas the balloon catheter cholangiograms demonstrated the presence of intrahepatic stones in 21 patients and the absence in 17 (Table 3). In consequence of six safeguards built against possible complications (Table 5), only one case of hypotension due to vagovagal reflex was encountered (Table 4). Thus, the balloon catheter cholangiography proved to be a useful and safe method far full visualization of the intrahepatic ducts in selected cases where sufficient filling was impossible by conventional ERC. In patients with intrahepatic stones who undergo an operative or endoscopic treatment, fullextent cholangiograms immediately after the procedure are essential to negate the presence of retained stones. If a follow-up shows a stone in such patients, these films may be of great value to determine whether it is recurrent or residual. The balloon cholangiography, safe and repeatable, is extremely useful in this respect. In addition to the regular use of the balloon catheter, we have successfully attempted “selective” cholangiography of a hepatic duct on either side (Fig. 5 & 6). Also, a thinner, #5 French balloon catheter has been developed and utilized in endoscopic retrograde pancreatography using the indwelling method, improving visualization of fine branches and greatly facilitating the spot film compression study (Fig. 9).

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