Bile and Bile Duct Abnormalities [antikvár]

One of the most rapidly expanding fields in gastroenterology is that dealing with bile production, bile flow and diseases of the biliary tree. A wide variety of disciplines is involved in this area of basic and clinical research. The problems rangé from basic molecular research into bile formation, production of lithogenic bile, new methods of stone detection and therapy, both non-surgical and surgical, and other benign and malignant diseases of the biliary tree. The purpose of this supplement is to discuss the current state of our knowledge with respect to both the medical and surgical aspects of benign and malignant biliary tract diseases. Particular emphasis is alsó put on the current management of biliary tract infection, because even the most advanced endoscopic and nonsurgical drainage approaches often only partly resolve the problem of chronic biliary tract infection. Not only a knowledge of the bacterial species involved, with their peculiar properties, but alsó the antibiotic properties required to penetrate into the obstructed biliary tree ment full attention. Major progress is alsó being made in our understanding of the mechanisms leading to cholesterol crystal formation, and ultimately gallstone formation, both in the gallbladder and in the common bile duct. Currently, there is a bewildering rangé of possibilities for nonsurgical treatment of common bile duct stones, such as endoscopic sphincterotomy and stone extraction, mechanical lithotripsy, electrohydraulic lithotripsy, laser lithotripsy, extracorporeal lithotripsy, etc. The time is right to draw up a balance of the indications, usefulness and shortcomings of these various techniques, in order to choose the most appropriate therapy for any given patient. Malignancy within the biliary tract is on the increase. Most important for all the imaging techniques is the accuracy of staging, not only of the malignancy, but alsó of lymph node metastases. An in-depth analysis of the true usefulness of endoscopic retrograde cholangiography, percutaneous cholangiography, CTscanning, angiography, and, in particular, endoscopic ultrasonography, would seem more than appropriate at the present time. Equally important is the selection of the most appropriate modality for palliation of malignant jaundice, either via therapeutic endoscopic means employing stents, or by surgical resection and drainage. The most difficult challenges for both the physician endoscopist and the surgeon remain the bifurcation malignancies. In particular the high incidence of cholangitis after endoscopic attempts at stenting represents the most important argument for a thoughtful review of the proper place of endoscopic stenting as compared with palliative surgical resection and drainage of these malignancies. Equally important are the non-malignant bile duct abnormalities such as: sphincter of Oddi dysfunction or formation of choledochocoeles, which require sophisticated methods for proper diagnosis and therapy. It is to be hoped that this supplement of Hepato-Gastroenterology will play a useful role in creating a deeper understanding of both the medical and surgical problems in the biliary field. A broader insight into the various aspects of medical and surgical therapy will, hopefully, be reflected in decreased morbidity and mortality from biliary tract diseases in the future. G.N.J. Tytgat K. Huibregtse