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Etablierte und neue Entwicklungen in der biliären intraduktalen Diagnostik

Established and new developments in biliary intraductal diagnostics

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Der Gastroenterologe Aims and scope

Zusammenfassung

Hintergrund

Eine cholestatische Laborkonstellation (Erhöhung von alkalischer Phosphatase, γ-Glutamyl-Transferase, Bilirubin) etwa im Rahmen einer Routineblutuntersuchung oder ein Skleren-/Hautikterus stellen in der Regel die Leitsymptome einer Gallengangsstenose dar. Parallel treten gelegentlich auch unspezifische Oberbauchbeschwerden auf. Die Klinik der Gallengangsstenose ist aber äußerst variabel und das Spektrum der Differenzialdiagnosen ist groß. Es bedarf einer eingehenden Abklärung durch technische Verfahren.

Methoden

Sinnvollerweise erfolgt hier primär der transabdominale Ultraschall. In vielen Fällen ist darüber hinaus eine weiterführende Diagnostik notwendig. Hier kommen in der Regel CT, MRT oder endoskopisch retrograde Cholangiographie (ERC) zum Einsatz, die in den meisten Fällen eine Diagnose ermöglichen; anschließend kann mittels ERC entsprechend therapiert werden. In selteneren Fällen bedarf es zur Abklärung der genauen Genese der Gallengangsstenose einer weiteren, direkten Bildgebung im Gallengang.

Ziel der Arbeit

Ziel der vorliegenden Übersichtsarbeit ist es, etablierte und neue Entwicklungen in der biliären intraduktalen Diagnostik vorzustellen und entsprechend zu werten.

Abstract

Background

A cholestatic laboratory constellation of findings, i.e. increased levels of alkaline phosphatase, gamma-glutamyl transferase (gamma-GT) and bilirubin, within the framework of routine blood investigations or icterus of the sclera and/or skin, as a rule represent the main symptoms of a bile duct stenosis. Unspecific upper abdominal pain occasionally occurs in parallel. The clinical manifestations of bile duct stenosis are extremely variable and the spectrum of differential diagnoses is large. This requires a detailed clarification by technical procedures.

Methods

The primary application of transabdominal ultrasound would be logical here. Furthermore, in many cases extended diagnostics are necessary which as a rule include computed tomography (CT), magnetic resonance imaging (MRI) and endoscopic retrograde cholangiography (ERC) and in most cases allow a diagnosis. Subsequently, an appropriate therapy can be initiated using ERC. In rare cases, an additional direct imaging of the bile duct is necessary to clarify the exact genesis of the bile duct stenosis.

Aim

The aim of this review article is to present and evaluate established and new developments in biliary intraductal diagnostics.

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Einhaltung der ethischen Richtlinien

Interessenkonflikt. A. Meining gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren

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  1. II. Medizinische Klinik und Poliklinik (Gastroenterologie), Ismaninger Str. 22, 81675, München, Deutschland

    A. Meining

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Meining, A. Etablierte und neue Entwicklungen in der biliären intraduktalen Diagnostik. Gastroenterologe 9, 435–440 (2014). https://doi.org/10.1007/s11377-014-0908-1

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  • DOI: https://doi.org/10.1007/s11377-014-0908-1

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