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Unklare Gallengangsstenosen

Indeterminate bile duct strictures

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Der Gastroenterologe Aims and scope

Zusammenfassung

Der Nachweis und die exakte Beurteilung einer Gallengangsstenose kann ungeachtet aller Fortschritte in der bildgebenden und endoskopischen Diagnostik Schwierigkeiten bereiten und deshalb den Einsatz mehrerer Untersuchungsverfahren erfordern. Die Diagnostik stützt sich heute primär auf nichtinvasive Methoden wie Sonographie, Computertomographie und MRCP, die keine Morbidität oder Mortalität aufweisen. Invasive Verfahren – direkte Cholangiographie durch ERCP/PTC oder die Cholangioskopie – können neben der Gallengangsdarstellung/-inspektion durch gezielte Biopsien, Bürstenzytologien oder Feinnadelpunktionen (FNP) die diagnostische Sicherheit verbessern und die Diagnostik mit einer galleableitenden Therapie verbinden. Der endoskopische Ultraschall (EUS) mit EUS-gestützter FNP oder endoluminaler Applikation von Minisonden liefert zusätzliche Informationen für die Differenzialdiagnose einer unklaren Gallengangsstenose. Die kombinierte ERCP- und EUS-gestützte Gewebediagnostik erzielt die besten Ergebnisse. Die Entscheidung zwischen einer operativen Behandlung mit der Möglichkeit der definitiven Klärung einschließlich Heilung einer tumorbedingten Stenose und einer nichtoperativen Alternative (Dilatation/Gallenwegsdrainage) muss nach sorgfältiger Risiko-Nutzen-Abwägung erfolgen.

Abstract

The detection and exact evaluation of bile duct strictures can be difficult despite improvements in imaging procedures and endoscopy. Therefore, different methods are required. Sonography, computed tomography, and magnetic resonance cholangiopancreatography are noninvasive methods and are preferred as first diagnostic steps. Invasive procedures such as endoscopic retrograde cholangiopancreatography (ERCP)/percutaneous transhepatic cholangiography and cholangioscopy have a high diagnostic yield but are associated with significant morbidity and mortality. However, they offer the possibility for biliary drainage. Direct methods of tissue sampling via biopsy, brush cytology, or fine needle aspiration (FNA) are helpful to get a more accurate diagnosis. Endoscopic ultrasound (EUS) with EUS-guided FNA or miniprobes gives additional information about the differentiation of an indeterminate bile duct stricture. Combined ERCP- and EUS-guided tissue acquisition seems to be the best approach to tissue diagnosis. Surgical treatment offers the possibility of a definite diagnosis and curative treatment. Nonoperative dilation and drainage procedures are a real alternative only in possibly benign situations or palliative cases. The risk-benefit ratio must be calculated carefully.

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  1. Klinik für Innere Medizin I, Sana Klinikum Lichtenberg, Oskar-Ziethen-Krankenhaus, Fanningerstraße 32, 10365, Berlin, Deutschland

    H.J. Schulz

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Schulz, H. Unklare Gallengangsstenosen. Gastroenterologe 3, 6–13 (2008). https://doi.org/10.1007/s11377-007-0133-2

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  • DOI: https://doi.org/10.1007/s11377-007-0133-2

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