Techniques of Peroral and Percutaneous Choledochoscopy for Evaluation and Treatment of Biliary Stones and Strictures

Both peroral and percutaneous choledochoscopy have been utilized for treatment of difficult biliary stones, evaluation and sampling of strictures, and preoperative mapping of known cholangiocarcinoma. This review emphasizes the required equipment, operators, and techniques of peroral and percutaneous choledochoscopy with intraductal lithotripsy of biliary stones and tissue sampling of strictures. The efficacy of percutaneous choledochoscopy for difficult biliary stones has been demonstrated in several large series. However, due to its more invasive nature, percutaneous techniques should be reserved for intrahepatic strictures or stones that are inaccessible by a retrograde transpapillary approach. Peroral choledochoscopy is technically demanding and thus has been limited primarily to centers of excellence. Recent refinements in scope technology, designed to overcome some of the technical limitations, may lead to more widespread clinical use.