Intraductal endoscopy and endosonography of bile ducts

Intraductal endoscopy (IDUE) and intraductal sonography (IDUS) allow direct visual and sonomorphological examination of all major bile ducts. Both techniques are mainly indicated for the classification se biliary strictures of unknown dignity and for the pretherapeutic staging of biliary cancer. For staging of peripheral bile duct carcinomas or if the papilla of Vater is endoscopically inaccessible, the percutaneous transhepatic access is advantageous. In all other indications, the endoscopic transpapillary access should be preferred because of its lower complication rate. IDUS as well as IDUE successfully differentiate benign from malignant strictures with an accuracy of at least 75%. Sensitivity is reported to be improved to more than 95% by combining both techniques. Published data on IDUE and even more so on IDUS rely on relatively small numbers of patients and need to be confirmed by larger series Cholangioscopy has its well-established therapeutic role in the endoscopic control of electrohydraulic and laser lithotripsy of large biliary stones.