In order to confirm the clinical significance of choledochoscopy in the management of residual gallstones, we reviewed the results of choledochoscopic lithotripsy. For the last two and a half years, 93 patients(M:F=37.:56, mean age; 52 years)
received
262 sessions of choledochoscopy(mean: 2.8 sessions/patient). Choledochoscopy was performed via T-tube tract in 74 patients, via percutaneous transhepatic route (PTCS: percutaneous transhepatic cholangioscope) in 13 patients and via both ways in 3
patients. In 2 patients subcutaneous jejunostomy was used for access. It was postoperative trial in 81 patients and primary nonoperative trial in 12 patients with or without previous operation history longtime age. Once residual stones were
suspected
radiologically or clinically, choledochoscopic lithotripsy was tried first and if it failed, radiologic intervention was tried. Ultrasonography was performed later to confirm clearance. Among 93 patients, stones were completely removed in 76
patients
(81.7%). Causes of failure of stone removal were access failure by both methods (n=5), tube care problem(n=5), and no visit(n=1). There patients are under longterm repeated trial and in 3 patients with hepaticojejunostomy or terminal
cholangiocarcinoma
residual stones were left due to less aggressive trial. Twenty four patients needed electrohydraulic lithotripsy due to size of the stone. Choledochoscopy detected 7 cases of residual stones which had been not detected by cholangiography.
Conversely we
found air bubbles, fibrinoid material or necrotic debris instead of any residual stones by choledochoscopy in the 14 cases in which cholangiography had shown filling defects. Finally out of 77 cases with residual stones, 71 cases received
choledochoscopic trial and stones were completely removed in 60 cases (84.5%). Choledochoscopy only was successful in 52 cases(73.2%) and others needed radiologic intervention also. Choledochoscopy is a tool to confirm residual stones and to
remove
them
under direct vision, otherwise a significant proportion of them could be missed or misinterpreted. Choledochoscopy should be a part of essential tool for the management of choledocho- & hepatolithiasis.
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