Endosonographie der Choledocholithiasis und ihrer Differenzialdiagnosen

Zusammenfassung

Die Cholezystolithiasis ist eine häufige Erkrankung in den westlichen Industrienationen. Sie kann mittels des transabdominellen Ultraschalls mit hoher Sensitivität diagnostiziert werden. Die Choledocholithiasis ist eine Komplikation der Cholezystolithiasis. Sie tritt bei 5-20 % der Patienten mit symptomatischer Cholezystolithiasis auf. Die Choledocholithiasis ist mittels des transabdominellen Ultraschalls allerdings schwieriger nachzuweisen. Als Goldstandard der Diagnose und Therapie gelten die endoskopische retrograde Cholangio-Pankreatikographie (ERCP) mit endoskopischer Sphinkterotomie (EST). Die endoskopische Sphinkterotomie ist allerdings mit einem signifikanten Komplikationsrisiko behaftet. Es existieren Differenzialdiagnosen der Choledocholithiasis, die keiner Sphinkterotomie bedürfen, so dass die Choledocholithiasis präinterventionell diagnostiziert werden sollte. In der folgenden Übersichtsarbeit werden die bildgebenden Methoden unter besonderer Berücksichtigung der Endosonographie für die Beurteilung des hepatobiliären Systems dargestellt.

Abstract

Cholecystolithiasis is a common finding in Europe and the United States. Choledocholithiasis is a complication of cholecystolithiasis. It occurs in 5-20 % of the patients with symptomatic cholecystolithiasis. Transabdominal ultrasound for diagnosis of cholecystolithiasis has a high sensitivity. Diagnosis of choledocholithiasis is more difficult. The clinical and laboratory findings are neither sufficiently sensitive nor sufficiently specific. Endoscopic retrograde cholangiopancreatography (ERCP) combined with endoscopic sphincterotomy (EST) are still considered as the “gold standard” for diagnosis and treatment. ERCP and EST are invasive methods that are associated with a significant risk of complications. Furthermore, there are numerous differential diagnoses of choledocholithiasis to be taken into account which neither require endoscopic retrograde cholangiopancreatography for diagnostic nor endoscopic sphincterotomy for therapeutical reasons. Consequently, a pre-interventional, minimally invasive, and low-risk examination method for the detection of choledocholithiasis prior to performing endoscopic sphincterotomy should improve the management of suspected choledocholitiasis. We report on the literature in the diagnosis of hepatobiliary diseases especially with respect to endoscopic ultrasound.

Schlüsselwörter

Ultraschall - Endosonographie - endoskopischer Ultraschall - Choledocholithiasis

Key words

Ultrasonography - endosonography - endoscopic ultrasound - choledocholithiasis

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