Radiological intervention in the biliary duct for diagnostic and therapeutic purposes

Innovative therapeutic approaches have given rise to the need of more refined diagnostic methods in the biliary duct. Percutaneous transhepatic cholangioscopy furnishes information that may confirm the presence of bile duct stenoses and also permits biopsy specimens to be obtained in an endoscopy-guided procedure. Intraductal sonography holds out promise as a procedure for a more precise locoregional staging of malignomas. Percutaneous transhepatic drainage is obsolete as a method of permanent bile derivation and endoscopic or percutaneous implantations of a biliary prosthesis are now commonly carried out instead. Among the various methods of tumour ablation, intraductal irradiation treatment using the afterload technique is gaining increasingly in importance. Other means of eliminating neoplasms, like laser beams and bipolar probes, are at present still under investigation. The cholangioscope and some more recently developed tools are a valuable addition to the arsenal for the treatment of concretions in the bile ducts. (origl/MG)