Diagnosis and treatment of cancer of the bile duct with bile duct obstruction by ERCP and bougienage in Martha-Maria Hospital Munich

About the department

The Department of Pulmonology at the Martha-Maria Hospital in Munich offers the full range of medical services in the field of its ​​competence. The department provides patients with various laboratory, instrumental and interventional diagnostic examinations, as well as with highly effective medical care. Depending on the severity of the clinical case, the department's doctors carry out drug therapy, mechanical ventilation and many interventional therapeutic procedures. If it is necessary to perform surgery on the organs of the thorax, thoracic surgeons are engaged in the therapeutic process. Of particular interest to the department's specialists is the provision of medical care to patients with bronchial asthma, chronic obstructive pulmonary disease, pulmonary fibrosis, lung cancer and pulmonary hypertension. The department's specialists work in accordance with current clinical protocols and recommendations of professional societies. The Head Physician of the department is Dr. med. Andreas Fertl.

The specialists of the medical facility have been treating malignant tumors of the lungs, mediastinal organs and pleura for many years. The department also successfully copes with the treatment of lung metastases. Lung cancer is one of the most common types of oncology. The symptoms of this disease are non-specific (cough, shortness of breath, chest pain, hemoptysis, etc.) and manifest themselves in the advanced stages, which complicates the treatment process. To confirm lung cancer, the department's specialists use advanced imaging tests: X-ray, computed tomography, magnetic resonance imaging, etc. Doctors also perform interventional bronchoscopic procedures, which allow them to examine the inner surface of the bronchial tree. Biopsy is an integral part of the diagnostic protocol for suspected lung cancer as well. After a comprehensive examination, the attending physician makes an accurate diagnosis. If a patient has a malignant tumor in the lungs, the specialist determines the stage of the oncological process and its spread, on which further treatment tactics depend. The main treatment methods for lung cancer include surgical tumor resection, radiation therapy, and chemotherapy. The department's doctors quite often resort to multimodal therapy, which includes a combination of several techniques. A treatment regimen for each patient is developed during an interdisciplinary tumor board by doctors from related medical disciplines. The competence of the department's doctors also includes palliative treatment in patients with end-stage lung cancer. The goal of such therapy is to relieve pain and ensure a decent quality of life to the patient. In addition, patients often have airway obstruction or pulmonary hemorrhage in the advanced stages of oncology. In such cases, the department's pulmonologists perform modern endoscopic procedures.

The department also provides high-quality medical care to patients with benign respiratory diseases. The most common pathologies in clinical practice are bronchial asthma, chronic obstructive pulmonary disease, interstitial lung disease, and pulmonary hypertension. The treatment of the above mentioned pulmonary diseases includes the use of conservative methods. The patients are prescribed highly effective drug therapy regimens and well-chosen breathing exercises. The patients are also strongly recommended to quit smoking, if they have this bad habit.

Doctors have successful experience in the treatment of infectious respiratory diseases: pneumonia, tuberculosis, non-tuberculous mycobacteria and others. As a rule, a course of drug therapy is sufficient to restore the health of patients with such pathologies.

The department specializes in the diagnostics and treatment of the following diseases:

• Benign respiratory diseases
  • Chronic inflammatory lung diseases: bronchial asthma, chronic obstructive pulmonary disease
  • Infectious lung diseases: pneumonia, tuberculosis and non-tuberculous mycobacteria
  • Interstitial lung disease: idiopathic pulmonary fibrosis and lung lesions due to autoimmune diseases
  • Sarcoidosis
  • Pulmonary hypertension
  • Sleep-related breathing disorders and hypoventilation syndrome
• Malignant respiratory diseases
  • Lung cancer (small and non-small cell lung cancer and other endobronchial tumors)
  • Malignant pleural diseases: pleural mesothelioma
  • Metastases of other tumors in the lungs
• Other diseases and pathological conditions

The department's diagnostic and therapeutic range of services includes:

• Diagnostics
  • Heart and pulmonary function tests
    • Blood gas test
    • Spirometry
    • Body plethysmography
    • Lung diffusion test
    • Specific and nonspecific inhalation provocation tests
    • Respiratory muscle function assessment
    • 6-minute walk test
    • Spiroergometry
    • Ergometry
    • Long-term ECG and 24-hour blood pressure monitoring
    • Right heart catheterization, including vasoreactivity testing in pulmonary hypertension
  • Diagnostic bronchoscopy
    • Rigid and flexible bronchoscopy with biopsy
    • Endobronchial ultrasound scanning
    • Bronchoalveolar lavage
    • Diagnostics using a cryoprobe
  • Thoracoscopy
    • Pleurisy diagnostics 
    • Pleural biopsy
  • Diagnostic tests to detect allergic reactions
    • Prick tests and intracutaneous tests
    • IgE level determination
    • Inhalation provocation testing
  • Ultrasound diagnostics
    • Pleural puncture, ultrasound-guided biopsy of the lungs and lymph nodes
    • Abdominal ultrasound
    • Transthoracic and transesophageal echocardiography
    • Doppler scanning of the blood vessels
• Treatment
  • Thoracoscopy
    • Pleurodesis
  • Therapeutic bronchoscopy
    • Bronchoalveolar lavage
    • Thulium laser therapy
    • Endoscopic hemostasis
    • Removal of a foreign body from the trachea and bronchi
    • Implantation of tracheal and bronchial stents
    • Bronchial thermoplasty for bronchial asthma
    • Endoscopic lung volume reduction for COPD
  • Treatment of allergic reactions
    • Hyposensitization (subcutaneous immunotherapy, sublingual immunotherapy)
    • Adaptive decontamination for acetylsalicylic acid intolerance syndrome
  • Treatment of malignant tumors of the lungs, mediastinal organs and pleura, as well as metastases of other tumors in the lungs
    • Surgical tumor resection (in collaboration with thoracic surgeons)
    • Radiation therapy
    • Chemotherapy
    • Multimodal therapy combining several treatment options
    • Palliative care
  • Home mechanical ventilation
    • Initiation and follow-up monitoring of patients on invasive and non-invasive home mechanical ventilation

• Other diagnostic and therapeutic options