Diagnostik cholestatischer Erkrankungen

Abstract

Ultrasound and computed tomography have represented the most important primary imaging techniques in hepatobiliary disorders over the last 2 decades. The direct visualization either by endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC) still remains the gold standard in the evaluation of the extrahepatic bile duct. In the past decade, magnetic resonance cholangiopancreatography (MRCP) has increasingly been established as a noninvasive alternative, thereby reducing the necessity of ERCP as an invasive exploration of the biliary system. Liver biopsy is indicated for the histologic grading and staging of intrahepatic cholestatic disorders. Recently, molecular genetic studies have elucidated several mutations in genes of hepatobiliary transporters which are responsible for hereditary forms of cholestasis in man. Thus, molecular genetics may be of interest in single cases of unclassified cholestasis or familial syndromes and will contribute to the routine diagnosis of hereditary cholestatic syndromes in the future. In summary, application of these diagnostic tools will finally lead to an unequivocal diagnosis in the majority of cholestatic patients with consecutive rational therapy.

The contribution of new methods in cytology for increasing sensitivity in the diagnosis of extrahepatic bile duct lesions

“…10 ). The diagnosis of pathological changes in this region is further very difficult, due in particular to poor availability [11][12][13] .…”

Role of biliary tract cytology in the evaluation of extrahepatic cholestatic jaundice

“…[1] Extrahepatic cholestasis, characterized by dilated bile ducts, is caused by either a bile duct stone or stricture, with stricture most often related to a malignancy. [2]…”

“…[1] In addition to establishing an accurate anatomic diagnosis, it provides an etiological diagnosis with cytologic methods for evaluating biliary ductal epithelium by brushings and direct examination of bile and therapeutic biliary stenting to relieve symptoms of obstruction. [45]…”