Surgical evaluation of endoscopic retrograde cholangiography for biliary tract diseases.

We attempted to clarify the surgical usefulness and limitation of endoscopic retrograde cholangiography (ERC) by comparing with drip infusion cholangiography (DIC). ERC was carried out on 144 patients with clinical symptoms of biliary tract diseases. The success rate was 71.5 per cent. Indications for surgery were found in 83.9 per cent of the patients with positive ERC findings and in 50.5 per cent of the patients in whom ERC was successful. The false positive rate in ERC, as revealed during the surgery was 2.3 per cent. Failure of ERC occurred in 41 patients. Failure of cannulation was attributed to para-vaterian diverticulum in 11, post-gastrectomy states in 5, the duodenal papilla covered by a polyp or a large fold in 2, and choledocho-duodenal fistula in 1. The failure of cannulation in 22 could not be clearly defined. As ERC was successful in 3 out of 9 patients in whom this approach was unsuccessful in the first trial, ERC should probably be repeated if such was indeed required pre-operatively. Diagnostic significance of DIC before ERC revealed that such plays a definite role in screening patients.