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Interventionen bei benignen Gallengangstenosen

Interventions for benign biliary strictures

  • Gallenwege — Diagnostik und interventionelle Therapie
  • Published:
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Zusammenfassung

Aufgrund ihrer potenziell schwerwiegenden Konsequenzen bis hin zur biliären Leberzirrhose stellen benigne Gallenwegestenosen eine große diagnostische wie therapeutische Herausforderung dar. Neben entzündlichen Erkrankungen oder einem akuten Lebertrauma sind iatrogen bedingte Gallengangstenosen nach hepatobiliären chirurgischen Eingriffen mit etwa 95% die Hauptursache aller benignen Entitäten.

Die Diagnose sollte nichtinvasiv durch eine Magnetresonanz-Cholangiopankreatikographie (MRCP) gestellt werden. Die invasive Diagnostik in Form einer endoskopischen retrograden Cholangio-Pankreatikographie (ERCP) oder perkutanen transhepatischen Cholangiographie (PTC) sollte unklaren Fällen vorbehalten bleiben und erst vor geplanter Intervention erfolgen.

Bei der Behandlung von Gallengangstenosen kommen chirurgische und interventionelle Verfahren je nach Lokalisation und Ursache der Stenose zum Einsatz. Die besten Ergebnisse finden sich bei kurzstreckigen Gangstrikturen im Hauptgallengang. Interventionelle Verfahren wie Ballondilatation und/oder Stentapplikation mit begleitender Drainageneinlage erreichen Offenheitsraten bis zu 75% nach 5 und 55% nach 12 Jahren wobei die Gesamtkomplikationsrate zwischen 5 und 8% liegt. Die Rezidivneigung der Gallengangstenosen nach interventioneller Therapie kann aufgrund der Tatsache, dass es sich meist um narbige Fibrosen handelt, je nach Lokalisation der Stenose mit bis zu 66% sehr hoch sein.

Abstract

Due to their potential for serious consequences, even including biliary liver cirrhosis, benign biliary strictures pose a considerable diagnostic and therapeutic challenge. In addition to inflammatory disease or an acute liver injury, iatrogenically caused biliary strictures following hepatobiliary surgery represent in 95% of cases the main cause for all benign entities.

The diagnosis should be determined noninvasively with magnetic resonance cholangiopancreaticography (MRCP). Invasive techniques such as ERCP or percutaneous transhepatic cholangiography (PTC) should be reserved for unclear cases and first performed before the scheduled intervention.

Depending on the site and cause of the stricture, surgical and interventional procedures are employed in the treatment of biliary strictures. The best results are obtained in short-segment strictures of the main bile duct. Interventional methods such as balloon dilation and/or stent application with concomitant drain insertion achieve patency rates of up to 75% after 5 and 55% after 12 years with a total complication rate of 5–8%. Due to the fact that most of the cases involve cicatricial fibroses, predisposition for recurrence of biliary strictures after interventional therapy can be very high, ranging up to 66% depending on the localization.

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Authors and Affiliations

  1. Institut für Radiologie, Campus Lübeck des Universitätsklinikums Schleswig-Holstein

    A. Lubienski, K. Lubienski, J. Blietz & T. Helmberger

  2. Radiologisches Zentralinstitut, Krankenhaus Nordwest, Frankfurt am Main

    M. Duex

  3. Abteilung Radiodiagnostik, Universitätsklinikum Heidelberg

    G. W. Kauffmann

  4. Institut für Radiologie, Campus Lübeck des Universitätsklinikums Schleswig-Holstein, Ratzeburger Allee 160, 23538 , Lübeck

    A. Lubienski

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  1. A. Lubienski
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  2. M. Duex
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  3. K. Lubienski
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  5. G. W. Kauffmann
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  6. T. Helmberger
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Correspondence to A. Lubienski.

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Lubienski, A., Duex, M., Lubienski, K. et al. Interventionen bei benignen Gallengangstenosen. Radiologe 45, 1012–1019 (2005). https://doi.org/10.1007/s00117-005-1299-6

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  • DOI: https://doi.org/10.1007/s00117-005-1299-6

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