Abstract
The usefulness of our original model of a fine fiberscope (2.09 mm in external diameter) for peroral transpapillary cholangioscopy is presented. The scope can be applied using the same techniques employed in endoscopic nasobiliary drainage, without a need for papillotomy. Seven cases that were suspected of having lesions in the bile duct were examined. The patients' ages ranged from 35 to 79 years, and the male-to-female ratio was 4:3. Insertion of the scope through an untreated papilla was easy and successful in all cases. The scope could be introduced into a fine-bore choledochus, and even into intrahepatic ducts. A clear visual field could be promptly obtained by rinsing the bile duct through the working channel of the scope. The fine structure and color of the mucosal surface of a protruding lesion in the bile duct could be observed clearly. It was easy to ascertain the existence of tiny stones that could not be detected by ERCP. And the diagnosis of the type of choledochal stones was also possible. The authors think it is very important especially for young people, to preserve the function of the papilla, because long-term exposure to refluxing intestinal juice after papillotomy may cause disagreeable pathological changes on bile duct mucosa. Preoperative or detailed cholangioscopy, using this type of fine scope, is a very useful diagnostic procedure to prevent unnecessary surgical maneuvers, such as endoscopic papillotomy.
