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Cholangioscopy is one of the endoscopic examinations. It allows you to assess the condition of the intrahepatic and extrahepatic bile ducts. To obtain a clear visualization, modern video equipment or fiber optic devices are used.
Characteristics of the procedure
Choledochoscopy is performed using a maternal duodenoscope, which allows you to carefully examine the major duodenal papilla (MPD). Anatomically, this zone is located at the mouth of the bile and pancreatic ducts of the duodenum.
To identify indications for manipulation, the patient first undergoes retropancreatocholangiography, which is aimed at assessing the condition of the pancreatic and bile ducts, identifying stones and neoplasms.
For the most successful research, careful preparation is necessary. She has a special diet. It is forbidden to take food and liquid in the evening before the scheduled date of examination and in the morning on the day of the study, so as not to distort the results.
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 stimulates the production of saliva and gastric juice. Together, they make it difficult to test the condition of the mucous membranes of the organs under study.
When manipulation is scheduled for the morning, it is necessary to prepare in advance for the possible administration of drugs. For oral cholangioscopy, sedatives and appropriate pain medications will be needed, which are administered approximately half an hour before the procedure.
Particular attention should be paid to the possible development of an allergic reaction, therefore, in order to prevent anaphylactic shock, it is necessary to conduct an allergic test in advance.
Intraoperative cholangioscopy is performed under general anesthesia with the participation of an anesthesiologist.
Indications and possible contraindications
Most people who first encounter such an examination believe that they are sure to suspect neoplasms of the biliary tract. But in fact, there are many other reasons that are average indications for testing.
But even if a tumor of a malignant or benign nature is suspected, detected using cholangioscopy, an assessment of the location of the neoplasm and an accompanying biopsy is performed. If possible, the doctor immediately removes the tumor and installs a drain.
Among other reasons for receiving a referral for diagnostics, 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 with a stone or a parasite, which blocks the normal outflow of bile;
- placement of a stent aimed at expanding the diameter, followed by restoration of the outflow of pancreatic and liver secretions;
- washing the ducts with a purulent lesion;
- drainage of the liver ducts with an external type;
- congenital diseases.
The latter include Mirizzi’s syndrome, as well as Caroli’s disease.
But against the background of many positive aspects of the procedure, as well as a number of indications for the appointment, there are several serious contraindications. They should be taken into account in order 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 the associated destabilization of the heart muscle, for example, with angina pectoris with arrhythmia. This also includes abnormalities of pulmonary activity, exacerbation of bronchial asthma or chronic bronchitis.
The list of contraindications is supplemented by infectious diseases, mental disorders, problems with blood clotting, agonal states.
Separately, situations are considered when the risks of manipulation are an order of magnitude higher than the possible benefits, such a procedure is carried out only with the consent of the patient.
Technique of the procedure
Oral cholangioscopy is performed in the endoscopy room. The patient is placed on a medical couch on the left side, the arm is brought behind the back, and the right leg is bent at the knee.
To reduce the pain of the procedure, the nurse necessarily conducts local anesthesia, which involves anesthesia of the mucous membrane of the oropharynx with a solution of lidocaine.
Through the mouthpiece, a duodenoscope is inserted first into the esophagus, then into the stomach, duodenum and stops opposite the large duodenal papilla.
A special probe is inserted through the main apparatus, the diameter of which is 4 mm. With the help of a remote control, part of it advances to the biliary tract to assess the bile duct. Other channels will also be monitored:
- common hepatic;
- right hepatic;
- left hepatic;
- bubble
When a neoplasm is detected, pieces of material are taken with biopsy forceps, which are sent for histological examination to subsequently determine the type of tumor.
If stones are found in the patient, they are removed using the Dormia basket. But here some variations of the procedure are possible, since a large number of small stones cause a stepwise blockage of the duct, preventing the normal outflow of bile. In such a clinical situation, surgery will be much more effective in order to get rid of all the stones at once in one go.
Patients with suspected obstructive jaundice are under special attention. As a rule, manipulation is performed with the installation of a nasobiliary stent. This means that a small-diameter drainage tube is installed through the endoscope into the lumen of the biliary tract to drain bile and to sanitize with special antiseptic solutions.
The same procedure will be followed if the patient is found to have classic bile duct narrowing during the imaging process, as in this case a stent is also placed.
With intraoperative cholangioscopy, the algorithm of actions is preserved, but the method of access to the problem area changes, the study is carried out through an open surgical wound.
For surgical intervention, the maternal unit is not needed. The doctor will limit himself exclusively to the cholangioscope, as well as auxiliary tools for solving problems locally.
It is necessary to trust the manipulation of any kind to highly qualified professionals, since the risks of possible complications after diagnosis are quite high.