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Which imaging modalities should be used for biliary strictures of unknown aetiology?
  1. Dirk Domagk1,*,
  2. Johannes Wessling2,*,
  3. Beate Conrad3,
  4. Roman Fischbach4,
  5. Christina Schleicher5,
  6. Werner Böcker6,
  7. Norbert Senninger7,
  8. Achim Heinecke8,
  9. Walter Heindel9,
  10. Wolfram Domschke10,
  11. Torsten Kucharzik10
  1. 1Department of Medicine B, University of Muenster, Muenster, Germany
  2. 2Department of Clinical Radiology, University of Muenster, Muenster, Germany
  3. 3Department of Medicine B, University of Muenster, Muenster, Germany
  4. 4Department of Clinical Radiology, University of Muenster, Muenster, Germany
  5. 5Department of General Surgery, University of Muenster, Muenster, Germany
  6. 6Gerhard-Domagk-Institute of Pathology, University of Muenster, Muenster, Germany
  7. 7Department of General Surgery, University of Muenster, Muenster, Germany
  8. 8Department of Medical Statistics, University of Muenster, Muenster, Germany
  9. 9Department of Clinical Radiology, University of Muenster, Muenster, Germany
  10. 10Department of Medicine B, University of Muenster, Muenster, Germany
  1. Correspondence to:
    Dr D Domagk
    Department of Medicine B, University of Muenster, Albert-Schweitzer-Street 33, D-48129 Muenster, Germany;domagkd{at}uni-muenster.de

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Why is it so difficult to determine the nature of isolated biliary strictures? In patients with no history of biliary surgery, most bile duct strictures have to be considered malignant until proven otherwise. This usually leads to extensive usage of diagnostic imaging—in many cases even to explorative laparotomy. Furthermore, we usually have a “luxury problem”: doctors have to choose the appropriate imaging technique out of the wide range of endoscopic and radiological modalities. For this purpose, doctors should have information about each technique. In a multimodal approach, we prospectively analysed sensitivity and specificity for differentiation between malignant and benign strictures, penetration into surrounding tissues, vascular invasiveness and staging of lymph node.

We included patients with jaundice of unknown aetiology and suspected biliary stricture. According to the study protocol, patients underwent diagnostic laparotomy; alternatively, a long follow-up of more than 12 months …

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