Author/Editor		Mlinarič, Vladimir
Title		Diagnostični in terapevtski posegi na biliarnem traktu
Translated title		Diagnostic and therapeutic procedures in biliary tract diseases
Type		članek
Source		Endoskopska revija
Vol. and No.		Letnik 11, št. 25
Publication year		2006
Volume		str. 49-55
Language		slo
Abstract		Several noninvasive diagnostic techniques, including contrast-enhanced two-phase spiral CT, 3D ultrasound, and, the most important MR cholangiopancreatography, have been widely adopted in the recent years. Despite their high sensitivity and specificity rates, they have not yet replaced endoscopic retrograde cholangiography (ERCP), which remains the gold standard procedure in the diagnosis of biliary tract pathology. The algorithm for differential diagnosis involves the use of oesophagogastroduodenoscopy (EDGS) and endoscopic ultrasound in specific cases. EDGS is used to assess patency of the upper digestive tract, and to detect primary pathological changes and consequences of the diseases affecting the gallbladder, bile ducts or pancreas (malignant overgrowth, fistula formation, ulceration). Endoscopic ultrasound provides the most accurate information about ampullary and periampullary lesions, and changes in the common bile duct, gallbladder, and the adjacent great vessels and lymph nodes. ERCP done with other endoscopic surgical procedures, such as endoscopic papillotomy (ETP), electroresection of the ampulla of Vater, lithotripsy, retrieval of calculi and foreign bodies, dilatation of strictures and endoscopic bile drainage (stenting and nasobiliary tube placement), remains an irreplacable tool in the treatment of biliary tract diseases. When choosing the most appropriate approach to diagnosis and treatment of gallbladder and bile duct diseases one should consider the scope and limitations of individual techniques and their role in the complementary treatment of these diseases (endoscopy-surgery, interventional radiology and conventional and laparoscopic surgery).
Summary		V zadnjih letih uveljavljene neinvazivne diagnostične metode, kot so dvofazna spiralna računalniška tomografija z intravenskim kontrastom (spiralni CT), tridimenzionalni ultrazvok (3D-UZ), predvsem pa magnetnoresonančna holangiopankreatografija (MRCP), se po občutljivosti in specifičnosti sicer približujejo endoskopski retrogradni holangiografiji (ERCP), a je (še) ne morejo zamenjati kot zlati diagnostični standard pri boleznih biliarnega trakta. V algoritmu diferencialnodiagnostičnih postopkov imata v določenih primerih svoj pomen tudi ezofagogastroduodenoskopija (EGDS) in endoskopski ultrazvok (EUZ). S prvo ugotavljamo prehodnost zgornje prebavne cevi, morebitne primarne bolezenske spremembe ali sekundarne posledice bolezni žolčnika, žolčevodov in trebušne slinavke (maligno preraščanje, fistuliranje, ulkusna bolezen in drugo). Z EUZ doslej najbolj natančno med drugim ocenjujemo morebitne bolezenske spremembe ampularne in periampularne regije, skupnega žolčevoda, žolčnika in okolice (predvsem veliko ožilje in bezgavke). ERCP ostaja z operacijskimi endoskopskimi posegi, kot so endoskopska papilotomija (EPT), elektroresekcija Vaterijeve papile (ampulotomija), litotripsija, ekstrakcija kamnov in tujkov, dilatacija striktur in endoskopska biliarna drenaža (stentiranje in nazobiliarno sondiranje), nepogrešljiva pri zdravljenju bolezni biliarnega trakta. Pri izbiranju možnosti za ugotavljanje in zdravljenje bolezni žolčnika in žolčevodov je zato potrebno poznati domet oziroma omejenost posamezne metode in njeno mesto v komplementarni endoskopsko-kirurški, rentgensko-interventni in kirurški (klasičnem in laparoskopskem) obravnavi teh bolezni.
Descriptors		BILIARY TRACT SURGERY ENDOSCOPY, DIGESTIVE SYSTEM ENDOSONOGRAPHY CHOLANGIOPANCREATOGRAPHY, ENDOSCOPIC RETROGRADE CHOLELITHIASIS COMMON BILE DUCT CALCULI VATER'S AMPULLA CHOLANGITIS PANCREATITIS CHOLESTASIS LIVER TRANSPLANTATION