4679 Mother and baby cholangioscopy. a single centre experience, indications and limitations

Peroral Mother and Baby cholangioscopy (MBC) allows direct visualization of the biliary tree. The proceedure requires a dedicated duodenoscope (Mother scope) with a 5.5mm therapeutic channel through which a 4.5mm choledochoscope (baby scope) can instrument the biliary tract. The baby scope has bi-directional tip control and a therapeutic channel allowing brushings, biopsies, electrohydraulic lithotripsy (EHL) and laser lithotripsy to be undertaken. Methods: MBC has been undertaken at our institution from November 1992 in the treatment of selected patients and lesions which have resisted conventional endoscopic treatments or provided diagnostic diffeculties. All EHL was carried out with a Piezo electric lithotripter. Results: From November 1992 to March 1999, cholangioscopy was performed on 18 occasions in 16 patients (44% female and 56% male) with a median age of 64 (range 42-82 years). Choledocholithiasis was the indication in 14 patients (10 single stones, 4 multiple stones). In two patients the stones spontaneously cleared and no further action was required. EHL was performed in 12 patients, facilitating complete duct clearance in seven. Clearance was not possible in five patients, two were stented and remain well, three underwent surgical exploration of the common bile duct. In two of the 16 patients diagnostic MBC was performed, one for a problematic right hepatic ductal stricture which MBC revealed to be an unusual case of pan-sclerosing cholangitis. The 2nd patient had a right hepatic duct mass thought to be an impacted stone, MBC diagnosed an unusual case of biliary papillomatosis. A 100% success rate in intubation of the common bile duct was achieved and no proceedure related complications were encountered. Conclusion: Most stones can be delt with via conventional therapeutic ERCP, however experience has formulated the following indications for MBC. Lithotripsy of a single large ductal stone and impacted stones. Diagnosis of unusual strictures and filling defects. Limitations to MBC are multiple stones and CBD diameter (preferably ≥ 8mm). All patients undergo prior ERCP and sphincterotomy and at MBC balloon dilation of the ampulla is performed prior to insertion of the choledochoscope.