Study on the management in making progress of diagnostic ability for pancreatic and biliary tract diseases

According to the recent progress of image synthetic techniques, diagnostic ability for diseases of pancreas and biliary tract have been rpgressed. Main examinations of the image diagnosis are estimated such as ultrasonography (US), radioisotope, computed tomography (CT), endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC). The author father investigated the limit of each examinations and analysed the factors of findings of each examinations which influence to correct diagnosis. ERCP was superior for the diagnosis of pancreatic and biliary tract carcinoma. However, ERCP gave a little information concerning to the size of tumor, metastasis and the relationship between tumor and surrounding tissues. CT and US complemented these weak points. Gallstones was almost all diagnosed by US, however there were some cases in which gall bladder was not visualised. In such cases CT and US should be performed in order. When the choledochal stones is suspected, US should be performed first and ERCP m ust be followed by all means. In cases of hard differenciation between malignant tumor and stones, or in cases of unsucceeded ERCP, CT must be followed. When pancreatic or biliary tract malignancy was suspected, US should be chosen as a screening examination and next the detailed diagnosis of the lesion should be made by ERCP. Finally, size of tumor, existence of metastasis and infiltration have to examined by CT. At present time, the most reasonable order of the examination for pancreatic and biliary tract disease is to choice first US as screening and to be followed by ERCP and CT. (J.P.N.)