Interpretative problems in endoscopic retrograde cholangiopancreatography.

1. Of forty-one patients with biliary tract problems studied by endoscopic retrograde choledochopancreatography, interpretation of ductograms or endoscopic observations in ten could not be accomplished with ease for one or several reasons. 2. Although incomplete filling of the bile ducts usually signifies organic obstruction, this occasionally is not true. The specific origin and histologic character of the lesion causing bile duct obstruction are not delineated by retrograde endoscopic cholangiography. 3. Other occasional limitations of endoscopic cholangiography include difficulties in demonstrating minute stones, in recognizing confusing anatomic variations, and in defining the status of recurrent strictures. 4. Inflammatory changes in the duodenal papilla can simulate carcinoma, or vice versa, on the basis of observation by the endoscopist. The capability of achieving a pancreatogram does not rule out the presence of carcinoma at the ampulla producing jaundice. Current technics for biopsy of the papilla or ampulla are in some instances inadequate, making results of such procedures unreliable. 5. Although endoscopic retrograde cholangiopancreatography frequently permits acquisition of vital information for the surgeon and occasionally provides unexpected information of significance, interpretative difficulties in some instances always necessitate the correlation of findings with other available clinical information.