Zusammenfassung
Durch endoskopische Papillotomie und Steinextraktion können heute 80 bis 90 % der
Gallengangskonkremente entfernt werden.
Therapeutische Probleme entstehen bei großen oder impaktierten Gangsteinen, bei zusätzlichen
Gallengangstenosen, beim Mirizzi-Syndrom oder bei schwierigem Zugang zum Gallengang.
Mit Hilfe zusätzlicher Techniken wie mechanischer Lithotripsie, extrakorporaler Stoßwellen-Lithotripsie
(ESWL), intrakorporaler Lithotripsie (elektrohydraulische Lithotripsie, Laserlithotripsie)
oder perkutan-transhepatischer Techniken kann die Effektivität der Steintherapie auf
98 % erhöht und das Risiko des endoskopischen Eingriffs vermindert werden.
Für ausgewählte Hochrisiko-Patienten können transpapilläre Endoprothesen eine vorübergehende
oder längerfristige Behandlungsalternative sein.
Indikationen zur operativen Therapie sind die ineffektive endoskopische Therapie,
häufige Steinrezidive und der Verdacht auf ein cholangiozelluläres Karzinom.
Abstract
To day 80-90 % of bile duct stones can be treated non-operatively by Endoscopic Sphincterotomy
(EST) and stone extraction.
The main reasons for failure of routine endoscopic manoeuvres are large or impacted
stones, additional bile duct strictures, Mirizzi-Syndrome and difficult access to
the bile ducts.
Various nonsurgical techniques are available to increase the success rate and to decrease
the risk of endoscopic treatment: Mechanical lithotripsy, extracorporeal shock wave
lithotripsy (ESWL), intracorporeal lithotripsy (electrohydraulic lithotripsy, laserlithotripsy)
and percutaneous transhepatic procedures.
The application of these techniques helps to increase the effectivity of stone treatment
up to 98 % and to decrease the therapeutic risk. In elected high-risk patients biliary
endoprothesis can establish bile drainage and prevent stone impaction. Indications
for operative treatment of difficult bile duct stones are ineffective endoscopic therapy,
frequent stone reccurrence and suspected cholangiocellular carcinoma.
Schlüsselwörter
Gallengangsteine - EPT - Lithotripsie
Key words
Bile duct stones - EST - lithotripsy
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Prof. Dr. H.-J. Schulz
Oskar-Ziethen-Krankenhaus
Paritätisches Krankenhaus Berlin Lichtenberg
Klinik für Innere Medizin
Fanningerstr. 32
10362 Berlin
