Treatment of Bile Duct Obstruction in Germany
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Bile duct obstruction is a dangerous health condition that may cause jaundice, biliary colic, cholangitis, cholecystitis, pancreatitis, and cirrhosis. It often causes complications that require emergency surgery. However, with timely treatment, surgery can usually be avoided. Doctors in Germany use endoscopic techniques that are safe for health, which allow them to eliminate most of the obstacles to the outflow of bile into the intestine. Germany is one of the countries with the highest level of medicine. German surgeons and gastroenterologists use advanced techniques to restore the health of patients.
Content
- What is a bile duct obstruction?
- Causes of bile duct obstruction
- Diagnostics
- Treatment options
- How to undergo treatment in Germany
What is a bile duct obstruction?
Bile duct obstruction is a blockage of the biliary tract, which leads to the impaired outflow of bile from the liver to the intestine. Bile is a liquid containing bile salts, bilirubin, and cholesterol. It is constantly synthesized in hepatocytes. Then, the bile is transported through the bile ducts to the duodenum. This helps to digest fats.
Most of the bile enters the gallbladder through the cystic duct, where it is concentrated and temporarily stored. The rest of the bile flows through the common bile duct into the duodenum through the sphincter of Oddi. The flow of bile into the duodenum is regulated by cholecystokinin. This hormone controls the release of stored bile from the gallbladder and is responsible for relaxing the sphincter of Oddi.
Bile duct obstruction is usually caused by a mechanical obstruction to the bile flow at the level of the extrahepatic bile ducts. Bile duct obstruction can develop anywhere. It leads to severe complications such as liver failure, nutrient deficiencies, bleeding, and inflammation.
Cholestasis is the impaired bile outflow caused by damage to the intrahepatic bile ducts. This health condition can lead to jaundice and itchy skin. Cholestasis causes similar problems, but it is not related to bile duct obstruction and requires a different approach to treatment.
Gallstone disease is the most common reason of bile duct obstruction. The stones that enter the bile ducts cause blockage. The most severe manifestations of gallstone disease are cholangitis (bile duct inflammation) and cholecystitis (gallbladder inflammation). It can develop into peritonitis (peritoneal inflammation) if not treated promptly.
Causes of bile duct obstruction
Bile duct obstruction is not a separate disease, but just a term that means the presence of a mechanical obstacle in the path of the bile flow. This syndrome can develop in several disease varieties, and each pathology is treated differently.
Extrahepatic bile duct obstruction can be benign or malignant.
The benign one includes:
- choledocholithiasis (the presence of stones in the common bile duct);
- bile duct cysts;
- Mirizzi syndrome (the presence of stones in the cystic duct that compresses the bile ducts);
- primary sclerosing cholangitis;
- strictures (scars) due to the trauma to the duct wall with stones as they move into the intestine or due to the damage during surgery and endoscopic procedures.
The causes of malignant bile duct obstruction are as follows:
- cholangiocarcinoma (bile duct cancer);
- cancer of the head of the pancreas;
- cancer of the ampulla of Vater.
Rare causes include parasitic cholangiopathy (blockage of the ducts by parasites), AIDS cholangiopathy, and autoimmune cholangiopathy caused by attacks of the patient's immune system on the bile ducts.
Diagnostics
The main task of diagnostics is not really to make the very fact of an obstacle to the movement of bile but to determine the cause of this condition. The choice of treatment tactics depends on it. Inaccurate diagnostics can lead to ineffective treatment.
Laboratory tests include:
- blood biochemistry tests;
- complete and clinical blood count to assess the patient's health;
- antinuclear antibody tests;
- viral hepatitis tests;
- coagulation tests;
- tumor marker tests;
- bilirubin test;
- fecal occult blood test.
The instrumental examination methods are of the greatest importance in the diagnostics of bile duct obstruction. Patients who undergo treatment in Germany are offered the following procedures.
Abdominal ultrasound allows doctors to see stones, and assess the condition of the liver, gallbladder, and ducts. An ultrasound Doppler probe is used to examine the liver blood vessels.
An abdominal CT scan serves to clarify the results of ultrasound if a malignant process is suspected.
Gallbladder scintigraphy is a diagnostic test during which doctors inject a radioactive agent that is excreted with bile. Doctors detect it in the intestine and thus check whether the bile flows normally into the duodenum.
Magnetic resonance cholangiopancreatography is an advanced examination of the bile and pancreatic ducts that allows many patients to avoid invasive examinations. The check-up is carried out with contrast enhancement. The method can detect cholangiocarcinomas, strictures, or bile duct stones, as well as most other diseases that can cause bile duct obstruction.
Other tests can be used if clinically indicated:
- endoscopic ultrasound (with the insertion of a sensor into the duodenum);
- endoscopic retrograde cholangiopancreatography is an endoscopic examination of the ducts, mainly used for gallstone disease (this manipulation can be used not only as a diagnostic but also as a therapeutic procedure);
- percutaneous transhepatic cholangiography involves the insertion of a needle through the abdomen into the ducts;
- a biopsy is performed using a percutaneous or endoscopic method and is required to confirm cancer.
Germany offers very accurate diagnostics. The diagnosis is made in 1-2 days and sometimes within a few hours after the patient's admission to the hospital. Doctors have advanced equipment. Even invasive examinations are safe for your health and have a minimal risk of complications.
Treatment options
The treatment tactics depend on the patient's health condition and the established or possible etiology of the bile duct obstruction. With a stable health condition, most of the procedures are carried out on an outpatient basis, with regular monitoring in the gastroenterology hospital. However, if the patient develops a fever, signs of sepsis, and abnormal liver function, admission to the hospital for diagnostics and treatment is required. In patients with acute cholangitis, cholecystitis, and acute liver failure, the timing of medical care is especially important.
A treatment scheme depends on the origin of the bile duct obstruction. The cause must be identified and eliminated. Depending on the underlying disease, treatment tactics may be as follows.
Gallstone disease and choledocholithiasis. In most patients, the blockage of the bile ducts is caused by stones that are stuck in the bile ducts and become an obstacle to the bile outflow. Endoscopic sphincterotomy (dissection of the sphincter) is performed with stones up to 1,5cm in size. This way, the stones can pass into the intestine. With a stone size of up to 1cm, a more sparing balloon dilatation is performed. The sphincter is expanded with a balloon. Large stones require lithotripsy, which is a procedure for stone fragmentation. Doctors in Germany use a laser or an electro-hydraulic instrument for stone fragmentation. Sometimes there is a need for surgery: doctors remove the gallbladder and stones from the bile ducts. These surgical interventions are performed through a minimally invasive laparoscopic approach.
Bile duct strictures. These are cicatricial narrowings that occur due to surgery, endoscopic procedures, inflammation, and trauma to the walls with stones. They are treated with endoscopic procedures such as sphincterotomy and balloon dilatation. A stent can be implanted, when needed, but it needs to be changed every 4-6 weeks, so the method is used only as a "bridge" to surgery to stabilize the patient's health condition. If the problem cannot be solved with the help of an endoscopic procedure, an operation is performed: a biliary-enteric anastomosis is formed to bypass the narrowed site. Doctors in Germany perform surgery using a minimally invasive laparoscopic technique, which reduces the risk of com plications and the recovery time for patients. Such operations are safer for the health.
Resectable malignant tumor. Patients with such neoplasms require tumor removal surgery. In the case of pancreatic cancer, pancreaticoduodenal resection is performed – the head of the pancreas, duodenum, gallbladder, common bile duct, and other tissues that are involved in the tumor process are removed. The same operation is performed for duodenal cancer. In the case of a gallbladder tumor and bile duct cancer, doctors perform cholecystectomy with liver resection and lymph node dissection. After tumor removal, an anastomosis is formed for the outflow of bile into the intestine.
Inoperable malignant tumor. Although an inoperable tumor cannot be treated, it can be taken under control for a long time. Doctors use radiation therapy and modern drugs that inhibit the growth of cancer cells. The treatment method for bile duct obstruction depends on the prognosis. Some techniques are more traumatic, but ensure long-term results. Other treatment methods are sparing but the procedures have to be repeated regularly – doctors choose them only in case of a low patient life expectancy. The location of the tumor, cancer treatment methods, age, patient's health condition, and other factors are also taken into account. Doctors perform endoscopic (through the intestine) or percutaneous (through an abdominal puncture) drainage. The areas of the tumor that obstruct the flow of bile can be destroyed by laser or photodynamic therapy. It is possible to implant a stent in the bile duct and form a biliary-enteric anastomosis.
Parasitic diseases. The parasites are destroyed with conservative therapy. Endoscopic retrograde cholangiopancreatography with sphincterotomy is performed to restore the movement of bile. In the case of gallbladder invasion, doctors perform cholecystectomy (gallbladder removal), bile duct revision, and T-tube implantation.
Bile duct cysts. Patients with bile duct cysts require diagnostics to exclude a malignant process, such as endoscopic retrograde cholangiopancreatography and obtaining material for a cytological examination. It is possible to resect the cyst and create a biliary-enteric anastomosis.
How to undergo treatment in Germany
To take advantage of the latest advances in medicine and undergo treatment for bile duct obstruction in one of the German hospitals, you are welcome to contact the specialists of the Booking Health company. On our website, you can get up-to-date and accurate information about the cost of treatment in Germany, compare prices in different German hospitals and book a medical care program at the best price. If you book a medical care program via our website, treatment in Germany will be easier and faster for you, and the cost of treatment in Germany will be lower.
Please leave your request on the website of the international medical tourism agency Booking Health. Our employees will contact you, provide advice, and answer your questions. We will take care of the arrangements for your trip. We will provide the following benefits to you:
- We will select an advanced German hospital whose doctors specialize in the treatment of hepatobiliary diseases and achieve the best results.
- We will help you overcome the language barrier and establish communication with a doctor at the German hospital.
- The waiting period for treatment in Germany will be reduced for you, and you will receive medical help on the most suitable dates.
- We will reduce the price. The cost of treatment in Germany will be lower than usual. If booked through our service, it will be reduced due to the lack of overpricing and additional coefficients for foreign patients.
- Our specialists will solve any organizational issues: preparation of documents, transfer from the airport to the German hospital, and back, hotel booking, and interpreting services.
- We will prepare your documents and translate them into English or German. You do not have to undergo the previously performed diagnostic procedures.
- We will keep in touch with the German hospital upon the completion of your treatment in Germany.
- We will arrange additional treatment in Germany, diagnostics, or rehabilitation if required.
- We will buy medicines in Germany and forward them to your native country.
While the best specialists in the world take care of your health, the specialists of the Booking Health company will help you to reduce the cost of treatment in Germany and take care of all your travel arrangements.
Authors:
The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova and Dr. Sergey Pashchenko. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
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