Medical research and diagnostics

Cholangioscopy (choledochoscopy)

Cholangioscopy is one of the endoscopic studies. It allows you to assess the condition of the intrahepatic and extrahepatic bile ducts. To obtain clear visualization, modern video equipment or fiber-optic optical devices are used.

The essence of the method

Choledochoscopy is performed using a maternal duodenoscope. With its help, it turns out to carefully study the large duodenal nipple (BDS). The anatomically indicated zone is located at the mouth of the bile and pancreatic duct of the duodenum.

To identify indications for the manipulation, first the patient is given retro-pancreatocholangiography. It involves examination with contrasting ducts.

In order for everything to go as smoothly as possible, you will need to conduct thorough preparation. It provides for a special diet. It is forbidden to eat from the evening before the scheduled date of inspection. Breakfast is also forbidden in the morning. And all this time you can’t even drink, so as not to distort the results of the study.

You should also pay attention to quitting smoking about three hours before the set time. This severity is explained by the fact that nicotine is a catalyst that induces the production of gastric juice and saliva. Together, they make it difficult to test the condition of the mucous membranes of the body.

When the manipulation is prescribed in the morning, it is worthwhile to prepare in advance for the need for the introduction of drugs. With oral cholangioscopy, medications of a sedative spectrum of action are needed. Powerful painkillers are also used, which are administered about half an hour before the procedure.

But here it is worth paying special attention to a possible allergic reaction. In order to mitigate the risks of anaphylactic shock, it is necessary to conduct an allergic test in advance.

If the patient is sent for intraoperative cholangioscopy, then it is worth preparing for general anesthesia. This requires the participation of an anesthetist.

Indications and possible contraindications

Most people who first encountered such an examination, believe that they necessarily suspect neoplasms of the biliary tract. But in fact, there are many other reasons that are average readings for testing.

But even the classic suspicion of a tumor of a malignant or benign nature during cholangioscopy sometimes involves at the same time an assessment of the location of the neoplasm and a concomitant biopsy. If possible, the doctor immediately removes the tumor, installs drainage.

Among other reasons for obtaining referrals for diagnosis, there are:

  • the presence of stones in the bile ducts;
  • obstructive jaundice, which is caused by blockage of the lumen of the common bile duct by a stone or parasite, which blocks the normal outflow of bile;
  • stent placement aimed at expanding the diameter with subsequent restoration of the outflow of pancreatic and liver secrets;
  • washing the ducts with a purulent lesion;
  • drainage of the ducts of the liver by an external type;
  • congenital diseases.

The latter include Mirrisi syndrome, as well as Caroli's disease.

But against the backdrop of many positive aspects of the method, as well as a number of indications for the appointment, there are several serious contraindications. They should be noted to significantly reduce the risks of side effects.

Among the most important prohibitions, an acute period after a heart attack or stroke is noted. It is also extremely dangerous to intervene if the patient suffers from severe circulatory disorders and related ailments regarding the destabilization of the heart muscle. A striking example is angina pectoris with arrhythmia. This also includes anomalies in pulmonary activity, exacerbation of bronchial asthma or chronic bronchitis.

The list of contraindications is complemented by infectious diseases, mental disorders, problems with blood coagulation, agonal conditions.

Situations are considered separately when the risks of manipulation are an order of magnitude higher than the possible benefits. Also, no one will conduct the procedure against the will of the patient.

How does this happen?

To perform oral cholangioscopy, the victim is invited to the office of endoscopic examination of the stomach. The patient is laid on a medical couch on his left side, and his hand is wound behind his back. In this case, the right leg must be bent at the knee.

To reduce the percentage of pain, the nurse must conduct local anesthesia, which involves analgesia of the mucous membrane of the oropharynx. For this, a solution of lidocaine is used.

Through the mouthpiece, the doctor will conduct a duodenoscope first into the esophagus, and then lower it into the stomach, duodenum and stop in front of the large duodenal nipple.

A daughter device is introduced through the main unit, the diameter of which is 4 mm. By operating the device with the help of levers at a distance, the specialist will reach the bile ducts with the distal part to evaluate the bile duct. Other channels will also be monitored:

  • total hepatic;
  • right hepatic;
  • left hepatic;
  • cystic.

If neoplasms are found in the study area, then biopsy forceps will be used. They are able to cover pieces of material that are sent for histological examination in order to further determine the specific type of tumor.

And if the patient has stones, then they are removed using the Dormia basket. But here some difficulties are possible. When the victim has a large number of stones of small gradation, they produce a stepwise blockage of the duct, preventing bile from moving normally. In this situation, it is much more effective to use the possibilities of surgical intervention in order to get rid of all stones at once.

Particular attention was paid to those people who suspect jaundice of mechanical origin. Most likely, the manipulation will not do without staging a nasobiliary format stent. This means that through an endoscope, a specialist will install a drainage tube into the lumen of the biliary tract. It must have a small working diameter in order to have time to remove bile in a roundabout way, as well as carry out rehabilitation stages with special solutions of the antiseptic spectrum of action.

According to an identical principle, a scenario will develop if, during the visualization process, it turns out that a person has a classic narrowing of the bile duct. Here, too, one cannot avoid installing the stent.

A little more complicated is the intraoperative cholangioscopy. Although the algorithm of actions is saved there, the way of access to the problem area is changing. Instead of administering an oral device, the doctor will conduct an examination through an open surgical wound.

For surgical intervention, the mother unit is not needed. The doctor will confine himself solely to the cholangioscope, as well as auxiliary tools for solving problems locally.

Only professionals with a good reputation should entrust manipulation of any kind only, since the risks of possible complications after diagnosis are quite high.

The author of the article:
Izvozchikova Nina Vladislavovna

Specialty: infectious disease specialist, gastroenterologist, pulmonologist.

Total length of service: 35 years.

Education: 1975-1982, 1MI, San Gig, highest qualification, infectious diseases doctor.

Science degree: doctor of the highest category, candidate of medical sciences.

Training:

  1. Infectious diseases.
  2. Parasitic diseases.
  3. Emergency conditions.
  4. HIV
Other articles by the author

Watch the video: Procedural Animation Demonstrating use of the SpyGlass Single Use Operator Cholangioscopy System (April 2020).

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