Choledochoscopy provides a direct visualization of the interior of the biliary tract. It permits a complete evaluation of the lumen and mucous membrane of the common bile duct and its divisions, ranging from the third order of intraphepatic ducts proximally to the sphincter and duodenum distally (Fig. 1). This precise, immediate evaluation of the biliary passages and the sphincter should obviate those factors in the postcholecystectomy syndrome which have their locus in the biliary tract.
Endoscopy should significantly minimize the residual calculus problem. This is particularly true for stones retained in the hepatic ducts, which, according to Norman, harbor 23.6% of calculi in choledocholithiasis.1 Recognition of organic narrowing of the distal end of the duct as a precursor to calculus formation is a determining factor of value in deciding upon choledochoduodenostomy rather than choledocholithotomy as the surgical procedure of choice.2-4
The biliary-tract surgeon is presented with the problem