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Endoskopie heute 2004; 17(1): 2-10
DOI: 10.1055/s-2004-818755
Übersicht

© Georg Thieme Verlag Stuttgart · New York

Der Problemstein im Gallengang

Difficult Bile Duct StonesH.-J. Schulz1
  • 1Klinik für Innere Medizin, Paritätisches Krankenhaus Berlin Lichtenberg, Oskar-Ziethen-Krankenhaus
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Publication History

Publication Date:
12 March 2004 (online)

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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

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