Gallenwegserkrankungen - neue Erkenntnisse und Entwicklungen

Abstract

This article focuses on the new insights and developments in biliary tract disorders. In patients with large bile duct stones, balloon dilation after the after endoscopic sphincterotomy appears to be an effective alternative to mechanical lithotripsy. A 2-month biliary stenting reduces stone size and number of stones. Early laparoscopic cholecystectomy in patients with cholezysto- and choledocholithiasis appears to be safe and might prevent biliary complications in the period following sphincterotomy. A bile sample collected during cholangiography for microbiological analysis is a simple, potentially valuable, diagnostic tool in patients with cholangitis. Each center should recognize its own patterns of infection to ensure ideal targeted therapy. In patients with primary biliary cirrhosis (PBC), development of fatigue is an independent risk factor of increased mortality. The risk of osteoporosis is increased in women with PBC and their risk of fracture increased significantly already at a T-score lower than -1.5. For PBC-patients not responding on UDCA-therapy, fenofibrate may be a new therapeutic approach. The incidence of primary sclerosing cholangitis (PSC) increases significantly in Scandinavia. In PSC patients with dominant stenosis the additional presence of inflammatory bowel disease is associated with an increased risk of cancer and a decreased survival. The risk of osteoporosis in PSC patients is significantly increased, especially in those with long-standing inflammatory bowel disease. In patients with advanced cholangiocarcinoma, bilateral stenting of the bile ducts is associated with better prognosis. The combination therapy with gemcitabine and cisplatin is an appropriate option for the treatment of patients with advanced biliary cancer.