[Endoscopy in cholestasis].

Abstract

The spectrum of causes of cholestasis ranges from microscopically recognizable damage to the parenchymal cells of the liver to obstruction of the ductus choledochus und papilla Vateri. Liver biopsy on the one hand and ERCP on the other therefore constitute the morphological methods that come closest to the pathological substrate. Obligatory sonography serves the restriction of diagnosis to a large extent. Laparoscopy is nearly always dispensable. Even in case of liver biopsy the therapeutic consequences should have an influence. Consequently, for transpapillary endoscopic methods in obstructive jaundice it is essential to remove the obstruction (papillotomy and extraction of the calculus or nasobiliary probe or intraluminal tube) if possible in one and the same session. The purely diagnostic ERC possibly causes dangerous cholangitis in mechanical icterus. Transpapillary and percutaneous transhepatic endoscopic methods are becoming more and more sophisticated and new indications are being discovered. However, the results of sonography and endoscopy in obstructive jaundice depend very much on the equipment available and experience of the investigator. He should realistically estimate what he is able to do as well as the patients' chances of recovery. In addition he should maintain contact to large departments of surgery and endoscopy.