Verschlußikterus — diagnostische Strategien — „mehr“. Invasive Techniken

  • M. Jung
  • A. Zipf
  • J. Rädle
Conference paper
Part of the Deutsche Gesellschaft für Chirurgie book series (DTGESCHIR, volume 1994)

Zusammenfassung

Invasive Untersuchungsmethoden beim Verschlußikterus sind ERCP/PTC, Endosonographie, Angiographie, Laparoskopie und die duktale Endoskopie. ERCP/PTC sind die Verfahren der ersten Wahl mit direkter Darstellung der biliären Obstruktion und einer Sensitivität von 99%. Sie besitzen mit ihren assoziierten Methoden (Sphinkterotomie, Stenting) auch immer eine therapeutische Option. Die Endosonographie behauptet ihren Platz im Tumorstaging des Pankreas und weniger des Gallengangskarzinoms. Angiographie, Laparoskopie und duktale Endoskopie sind speziellen Fragestellungen vorbehalten. „Weniger ist mehr” bedeutet in der Abklärung des Verschlußikterus einen rationalen Einsatz an bildgebenden Verfahren, jedoch ohne Verzicht auf invasive Techniken.

Schlüsselwörter

Verschlußikterus Invasive Techniken ERCP bildgebende Verfahren 

Diagnostic Strategies in Obstructive Jaundice — Invasive Techniques

Summary

ERCP/PTC, endosonography, angiography, laparoscopy, and small-caliber endoscopy are invasive techniques used in the diagnostic workup of obstructive jaundice. ERCP and PTC are the preferred tests to evaluate a biliary obstruction with a 99% sensitivity. Together with the complementary methods of sphincterotomy and stenting, these investigations have a considerable therapeutical potential. Endosonography is the method of choice in staging pancreatic carcinoma, but its role in staging cancer of the biliary tract has not been proven. Angiography, laparoscopy, and small-caliber endoscopy are procedures for special indications. “Less is more” as a strategy for biliary obstruction means endoscopic methods are the first choice for diagnosis and therapy and a more rational approach to imaging techniques.

Key words

Obstructive jaundice Invasive techniques ERCP Imaging techniques 

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Literatur

  1. 1.
    Brandabur JJ, Kozarek RA, Ball TJ, Hofer BO, Ryan JA, Traverso LW, Freeny PC, Lewis GP (1988) Nonoperative versus Operative Treatment of Obstructive Jaundice in Pancreatic Cancer: Cost and Survival Analysis. Am J Gastroenterol 83:1132–1139PubMedGoogle Scholar
  2. 2.
    Burcharth F (1985) Approach to the jaundiced patient: diagnosis and treatment. Ann Radiol (Paris) 28:170–174Google Scholar
  3. 3.
    Cotton PB (1982) Duodenoscopic placement of biliary prostheses to relieve malignant obstructive jaundice. Br J Surg 69:501–503PubMedCrossRefGoogle Scholar
  4. 4.
    Cotton PB (1984) Endoscopic methods for relief of malignant obstructive jaundice. World J Surg 8:854–861PubMedCrossRefGoogle Scholar
  5. 5.
    Frank BB (1989) Clinical Evaluation of Jaundice. JAMA 262:3031–3034PubMedCrossRefGoogle Scholar
  6. 6.
    Harbin WP, Mueller PR, Ferrucci JT (1980) Transhepatic cholangiography: complications and use patterns of the fine-needle technique. Radiology 135:15–22PubMedGoogle Scholar
  7. 7.
    Jung M, Manegold BC (1990) Komplikationen durch ERCP und assoziierte Methoden. In Henning H, Manegold BC (Hrsg). Fortschritte der gastroenterologischen Endoskopie. Demeter-Verlag, 97–103Google Scholar
  8. 8.
    Jung M, Zipf A, Schoonbroodt D, Caspary WF (1994) Pancreatoscopy for differential diagnosis of pancreatic duct stricture. Gastroenterology 106A:299Google Scholar
  9. 9.
    Kreek MJ, Balint JA (1980) “Skinny needle” cholangiography – results of a pilot study of a voluntary prospective method for gathering risk data on new procedures. Gastroenterology 78:598–604PubMedGoogle Scholar
  10. 10.
    Kurzawinski T, Deery A, Davidson BR (1993) Diagnostic value of cytology for biliary stricture. Br J Surg 8:414–421CrossRefGoogle Scholar
  11. 11.
    Mueller PR, van Sonnenberg E, Simeone JF (1982) Fine-Needle Transhepatic Cholangiography. Ann Intern Med 97:567–572PubMedGoogle Scholar
  12. 12.
    Olen R, Pickleman J, Freeark RJ (1989) Less Is Better. The Diagnostic Workup of the Patient With Obstructive Jaundice. Arch Surg 124:791–795PubMedCrossRefGoogle Scholar
  13. 13.
    Reiertsen O, Skjoto J, Jacobsen CD, Rosseland AR (1987) Complications of fiberoptic gastrointestinal endoscopy. Endoscopy 19:1–6PubMedCrossRefGoogle Scholar
  14. 14.
    Richter JM, Silverstein MD, Shapiro R (1983) Suspected obstructive jaundice – a suspicion analysis of diagnostic strategies. Ann Intern Med 98:51Google Scholar
  15. 15.
    Riemann JF, Kohler B, Harloff M, Weber J (1989) Die transpapilläre Cholangioskopie. Dtsch med Wschr 114:1775–1779PubMedCrossRefGoogle Scholar
  16. 16.
    Riemann JF (1993) Mini-Endoskopie des bilio-pankreatischen Systems. Z Gastroenterol 31:156–157PubMedGoogle Scholar
  17. 17.
    Robinson HB, Smith GW (1976) Applications for Laparoscopy in General Surgery. Surg Gynecol Obstet 143:829–834PubMedGoogle Scholar
  18. 18.
    Rösch T, Lorenz R, Braig C, Feuerbach S, Siewert JR, Schusdziarra V, Classen M (1991) Endoscopic ultrasound in pancreatic tumor diagnosis. Gastrointestinal Endoscopy 37:347–352PubMedCrossRefGoogle Scholar
  19. 19.
    Rösch T, Braig C, Gain T (1992) Staging of pancreatic and ampullary carcinoma by endoscopic ultrasonography. Gastroenterology 102:188–199PubMedGoogle Scholar
  20. 20.
    Scharschmidt BF, Goldberg HI, Schmid R (1983) Current concepts in diagnosis. Approach to the Patient with Cholestatic Jaundice. N Engl J Med 308:1515–1518PubMedCrossRefGoogle Scholar
  21. 21.
    Shepherd HA, Royle G, Ross APR, Diba A, Arthur M, Colin-Jones D (1988) Endoscopic biliary endoprosthesis in the palliation of malignant obstruction of the distal common bile duct: a randomized trial. Br J Surg 75:1166–1168PubMedCrossRefGoogle Scholar
  22. 22.
    Siewert JA (1992) Staging des Pankreaskarzinoms: wozu und wie? Bildgebung 19 (Suppl 1): 17Google Scholar
  23. 23.
    Soehendra N, Grimm H, Berger B, Nam VC (1989) Malignant Jaundice: Results of Diagnostic and Therapeutic Endoscopy. World J Surg 13:171–177PubMedCrossRefGoogle Scholar
  24. 24.
    Speer AG, Cotton PB, Russell RCG, Mason RR, Hatfield ARW, Leung JWC, MacRae KD, Houghton J, Lennon CA (1987) Randomised trial of endoscopic versus percutaneous stent insertion in malignant obstructive jaundice. Lancet II: 57–62Google Scholar
  25. 25.
    Summerfield JA (1988) Biliary obstruction is best managed by endoscopists. Gut 29:741–745PubMedCrossRefGoogle Scholar
  26. 26.
    Tio TL, Cheng J, Wijers OB, Sars PRA, Tytgat GNJ (1991) Endosonographic TNM Staging of Extrahepatic Bile Duct Cancer: Comparison With Pathological Staging. Gastroenterology 100:1351–1361PubMedGoogle Scholar
  27. 27.
    Warshaw AL, Tepper JE, Shipley WU (1986) Laparoscopy in the Staging and Planning of Therapy for Pancreatic Cancer. Am J Surg 151:76–80PubMedCrossRefGoogle Scholar
  28. 28.
    Wiechel KL (1986) Perkutane transhepatische Cholangiographie. In: Hess W (Hrsg) Die Erkrankungen der Gallenwege und des Pankreas. Padowa: PicciniGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1994

Authors and Affiliations

  • M. Jung
    • 1
  • A. Zipf
    • 1
  • J. Rädle
    • 1
  1. 1.Medizinische Klinik IIKlinikum der Johann Wolfgang Goethe-UniversitätFrankfurt am MainDeutschland

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