Transfistula fibrocholangioscopy: diagnosis and correction for major duodenal papilla drainage disturbances

Aim. To explore the potential of transfistula fibrocholangioscopy for the definite diagnosis and correction of drainage disturbances in the major duodenal papilla and the terminal portion of the common bile duct.
Materials and methods. In the period of 2017–2019, we examined 230 patients with functioning external biliary drains, who underwent surgery in the hospitals of the region. Residual concrements were identified and removed from the bile ducts of 158 patients through external biliary fistulas. The research methodology involved monitoring the external bile flow rate, fistulocholangiography and transfistula fibrocholangioscopy to examine bile outflow through the common bile duct and major papilla before and after stones removal, elimination of cholangitis and papillitis.
Results. The examination of 37 patients revealed no obstruction to bile drainage. After eliminating the cause of papillitis (cholangiolithiasis, drainage) and inflammatory changes the bile outflow through the major papilla was restored in 112 patients. The bile outflow disturbance persisted in 81 patients after removal of abnormalities in the terminal portion of the common bile duct and major papilla. 70 of them underwent the graduated 'rendezvous' papillotomy, and seven – antegrade balloon dilatation. Four patients underwent a rendezvous papillotomy with antegrade balloon dilatation. The failure rate was 1.2%, complications – 9.9%, including III–IV grade complications (2.5%) according to the Clavien–Dindo classification. One patient died (1.2%).
Conclusion. Antegrade transfistula fibrocholangioscopy methods of endobiliary examination and bile duct sanitation comprise a valuable contribution to modern biliary surgery. They are mostly appropriate to be applied in centers which a focus on residual diseases of the bile ducts.

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