Zusammenfassung
Die klinische Erstmanifestation der Gallengangsstenose ist häufig der Ikterus. Die Differenzialdiagnose ist demzufolge relativ vielfältig und komplex. Primär ätiologisch zu unterscheiden sind maligne von benignen (entzündlichen) Faktoren. Weitere Abgrenzungskriterien sind Höhe bzw. Lokalisation der Stenose. Diagnostisch eingesetzt werden sowohl nichtinvasive (Ultraschall, MRT/MRCP) als auch invasive Verfahren (ERCP, PTCD), wobei bei der Diagnosestellung häufig schon die klinische Notwendigkeit einer Gallengangsdrainage via ERC zur Vermeidung einer Cholangitis besteht. Zur Aufrechterhaltung der Drainagefunktion stehen mittlerweile unterschiedliche Verfahren zur Verfügung. Hier kommen neben dem alleinigen Stenting (v. a. bei benignen Stenosen) auch ablative Verfahren (etwa beim Klatskin-Tumor) in Betracht.
Abstract
Jaundice is often the first clinical manifestation of biliary strictures hence the differential diagnosis remains manifold and complex. Bile duct strictures may be of benign (inflammatory) or malignant origin. Further differentiation depends also on the localization and level of stenosis. Non-invasive procedures, such as ultrasound, magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) and invasive procedures, such as endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography and drainage (PTCD) are available as diagnostic tools. However, there is often a clinical need for biliary drainage (via ERCP) before a precise diagnosis can be established. To ensure biliary drainage, various methods are now available which include stenting alone (especially for benign stenoses) and also ablation of neoplastic tissue (such as used for treating Klatskin tumors).
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Interessenkonflikt. A. Meining gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Meining, A. Gallengangsstenosen. Gastroenterologe 9, 473–481 (2014). https://doi.org/10.1007/s11377-014-0901-8
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DOI: https://doi.org/10.1007/s11377-014-0901-8