Improved Visualization of Intrahepatic Bile Ducts by Endoscopic Retrograde Balloon Catheter Cholangiography

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Abstract
In 7 patients with a patulous sphincter of Oddi, choledochoduodenal fistula, previous sphincterotomy, sphincteroplasty or bilioenteric anastomosis in which standard endoscopic retrograde cholangiography (ERC) with a # 5 French catheter failed to visualize intrahepatic ducts sufficiently due to a backflow of contrast into the duodenum, ERC was attempted via a balloon catheter to prevent escape of contrast. The results were compared with those using a 7 French catheter. In contrast to the latter, which gave only insufficient filling of hepatic ducts, the former permitted full visualization in all cases. Consequently, intrahepatic stones were demonstrated in 3 patients and bile duct changes consistent with carcinoma in another. The absence of hepatic lesions was confirmed in the remaining 3 patients. No adverse reactions were experienced. The use of a balloon catheter evidently constitutes an effective aid in ERC for the diagnosis of hepatic lesions in selected cases where conventional ERC fails.