The role of endoscopy of the biliary tract in assessing the function of the ampulla of Vater.

In a prospective series of 53 consecutive explorations of the common bile duct, there were 12 patients in whom no contrast material entered the duodenum on postexploratory cholangiography. In 11 of these patients, the choledochoscope had been used to visualize the ductal anatomy and in each instance the ampulla of Vater was visualized from within and judged to be patent. Calibration, not dilation of the ampulla was performed upon ten of the patients. Transient edema or spasm of the ampulla secondary to operative trauma, stone removal or underlying disease was diagnosed and in each patient the operation was terminated after the cholangiogram. Follow-up cholangiography in each instance demonstrated a patent ampulla, free flow into the duodenum and no strictures or stones. It is concluded from these data that with operative choledochoscopy the anatomy and pathologic characteristics of the biliary tract can be visualized and the patency of the ampulla of Vater can be assessed.