K. Paraskeva, Nea Ionia, GR

This educational poster aims to refresh our knowledge about commonest causes of bile duct strictures and furthermore to help radiologist to get familiarized with classic fluoroscopic images enriched by beautiful endoscopic images of choledochoscopy.

Background

Bile ducts consist a complex network with intrahepatic and extrahepatic part. Intrahepatic bile ducts should measure in diameter up to 2mm., common bile duct up to 6-8mm (<10mm after cholocystectomy). Several reasons cause bile duct strictures and can be benign (such as inflammatory, iatrogenic reasons, liver transplantation etc) or malignant (ie cholangiocarcinoma). Bile duct stenoses are relatively uncommon but quite challenging condition, requiring accurate diagnosis and multidisciplinary approach.

Imaging findings OR Procedure findings

In our department and in close collaboration with gastroenterologists, we perform ERCP almost routinelly on daily basis. Fluoroscopy is considerable help for regional anatomy, recognition of variants and catheter guidance. Using spy-glass endoscope is an important tool assessing bile duct stenosis, offering unique images from inside the stenotic region, where simple catheters are not able to approach. Additionally, using spy glass we achieved to reduce fluoroscopy time. The last 20 months we have performed about 18 choledochoscopes.

Conclusion

Bile duct strictures are relatively common in departments with high rates of liver-pancreas and bile ducts pathology, such as in our hospital. Symptoms can vary from obscure to noisy. Accurate diagnosis is crucial, fluoroscopic imaging together with endoscopy offer spherical view of the stenotic area. Endoscopy treatment shares very good success rates, in comparison to surgery management.

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