JSLS Therapeutic Endoscopy of the Hepatobiliary and Pancreatic System: A Vietnamese Experience Le Quang Quoc Anh,MD ABSTRACT Introduction: Therapeutic endoscopic retrograde cholan- giopancreatography (ERCP) was initially utilized at Binh Dan Hospital, Viet Nam, in August 1993. From August 1993 through March 1997, 318 ERCP procedures were performed on 271 patients. It was not possible to obtain cholangiog- raphy in 32 cases of the 318 procedures of ERCP, for a suc- cess rate of diagnostic ERCP approaching 89%. Materials and Methods: Cases treated by ERCP included: 14 cases of Ascaris lumbricoides in the common bile duct (CBD). 69 cases of bile duct stones. 12 cases managed by nasobiliary catheter drainage. 3 cases treated by bile duct stent. Sphincterotomy was attempted on 108 cases. Complications included: 5 cases of acute pancreatitis. 7 cases of purulent cholangitis, which resulted in 1 death. 2 cases of retroperitoneal duodenal perforation. 9 cases of postsphincterotomy bleeding. INTRODUCTION Biliary tract infection due to cholelithiasis is a common sur- gical emergency in Viet Nam and requires, in many instances, early decompression. But decompression, as an emergency procedure, is not always a curative procedure and tends to have complications as well as mortality.4,5 Biliary tract obstruction due to recurrent gallstones or pre- vious surgical procedures for decompression often causes difficulties in localizing the biliary tract by endoscopic means.1,7,12 Similarly, postoperative residual bile duct or intrahepatic stones, recurrent cholangitis and bile duct strictures, either benign or malignant, offer significant difficulties to the oper- ating surgeon.9,13 Ascaris in the bile ducts or acute pancreatitis secondary to stones are not easily managed by medical means and surgi- cal intervention is fraught with danger and high morbidity. Also the surgical management of biliary obstruction in patients with concomitant medical diseases often has a poor prognosis.15,20 Conclusions: We conclude that ERCP is a useful thera- peutic modality for bile duct stones and parasitic worms in the bile ducts. Patients, especially young female patients, may be "haunt- ed" by large abdominal scars and suffer psychological trau- ma. Key Words: ERCP, Retained bile duct stone, Bile duct Ascaris. Endoscopy Unit, Binh Dan Hospital, Department of Digestive Surgery, Medical Training Center, Ho Chi Minh City, Viet Nam. Address reprint request to: Le Quang Quoc Anh, MD, Endoscopy Unit, Binh Dan Hospital, Department of Digestive Surgery, Medical Training Center, Ho Chi Minh City, Viet Nam. In order to obviate some of these problems, endoscopic cholangiographic techniques were introduced into our country and have played an important role at Binh Dan Hospital.7,16 In 1993, therapeutic endoscopic retrograde cholangiopancreatography (ERCP) was added to the treat- ment options available to patients at Binh Dan Hospital. MATERIALS Facilities: Duodenoscope TJF 20 with side view (Olympus). Source light. Monitor system. Cauterization and aspiration devices. Equipment: Five French catheters for cannulization of the ampulla of Vater. Papillotomy knife. Dormia basket (BML). Biopsy forceps. JSLS (1997)1:345-348 345