RETROGRADE CHOLANGIOGRAPHY WITH AN INDWELLING BALLOON CATHETER PLACED BY DUODENOSCOPY AND ITS APPLICATION TO PANCREATOGRAPHY

Abstract

In our previous report we demonstrated the usefulness of endoscopic retrograde balloon catheter cholangiography for better filling of intrahepatic bile ducts. The present article shows recent improvements of the technique on two points. First, an endoscope was removed, leaving the balloon catheter in the bile duct. Second, contrast medium was slowly infused at a constant rate using a heavy-duty infusion pump. The extended use of the improved technique for pancreatography is also described. To date we have performed the procedure on 39 patients, including 28 with prior shincterotomy or sphincteroplasty, to overcome poor visualization of the bile duct or pancreatic duct due to back flow of contrast medium on standard ERCP (37 patients), or to facilitate simultaneous pancreatography with percutaneous transhepatic portography (PTP) (2 patients). In 33 patients, where standard ERC failed to fill the intrahepatic ducts in most cases (inadequate visualization, 23 patients; hepatolithiasis suspected, 9; hepatolithiasis, 1), cholangiography under pressure with the balloon catheter successfully visualized the intrahepatic branches, confirming the presence of intrahepatic stones in 16 patients, cystic dilatation of the intrahepatic ducts in 2, and the absence of hepatic lesions in 15. The indwelling method diminished the patient's discomfort and facilitated the posture change while taking radiographs. Meantime, retrograde pancreatography with the balloon catheter was performed on 6 patients, and complete filling of peripheral branches was possible. A spot film study by compression in the supine position and simultaneous investigation by pancreatography and PTP have become feasible with the aid of the indwelling technique. No serious complicattion was encountered in the cholangiography group. One patient who underwent balloon catheter pancreatography developed infection to a pseudocyst of the pancreas, requiring percutaneous drainage under ultrasound guidance. Although great care should be taken to prevent possible adverse reactions, the indwelling balloon catheter procedure would be of benefit to improve duct visualization and to facilitate combined radiologic studies.