Endoscopic cytodiagnosis of the pancreas and bile ducts

During the last twelve years we made in 3868 cases cytological investigations of the pancreatic and bile duct systems. The techniques for endoscopic cell collection and microscopic observation are demonstrated. Cellular material consists of epithelia, inflammatory cells and tumor cells. Their cytological details are described. Of primary importance are the differentiations of the epithelial cells in cases of chronic cholangitis and pancreatitis from tumor cells. We found 211 cases with proven malignant tumors of the papilla, the pancreas or the bile ducts. In 81.5% of these cases a significant cellular material could be collected with 59.3% tumor cell diagnoses. No false-positive tumor cell diagnosis was found (n = 3657). A comparison with preoperative bioptic histology was possible only in the papilla region. Here, the sensitivity of histology was 60% compared to 86% sensitivity of cytology. We conclude that the cytodiagnosis of the papilla, the pancreas and the bile duct by means of endoscopic techniques can be done routinely in order to obtain a preoperative diagnosis of inflammatory as well as malignant cellular findings in these organs.     

Transabdominal sonography of bile ducts

Ultrasound is considered to be the initial imaging modality of choice for evaluation of bile ducts. In this article, sonographic anatomy of the bile ducts and ultrasound findings in congenital, inflammatory, neoplastic, and other abnormalities of bile ducts are described. Roles of color Doppler ultrasound and newer applications, such as harmonic imaging and three-dimensional ultrasound, in evaluation of bile ducts are discussed.     

Endoscopic palliative drainage of the bile ducts

Initial results of palliative endoscopic retrograde drainage of the common bile duct are reported. In 12 out of 19 patients the treatment was successful (63% cases). In every case the serum bilirubin level quickly decreased to normal values. The life span of the endoprostheses lasted on average for 3 months. No fatal complications occurred in connexion with prosthesis implantation. Endoscopic drainage of the common bile duct in patients with an inoperable tumour of the biliary tract represents an alternative procedure to palliative surgery in the management of malignant occlusion icterus.     

Radiographic assessment of anomalous bile ducts

We report 5 radiologically documented cases of anomalous bile duct drainage of a segment of the right lobe of the liver and/or the cystic duct. These anomalies may be suspected on preoperative, intraoperative, or postoperative cholangiograms by the lack of visualization of the bile ducts draining a focal portion of the right lobe of the liver (naked segment). They may also be diagnosed definitively by direct duct opacification. Radiologic diagnosis prior to cholecystectomy may prevent inadvertent ligation or injury to the aberrant duct.