Advances in the radiology of jaundice: a symposium and review

New radiologic imaging and interventional techniques have transformed the clinical management of biliary obstruction. Selected aspects of their application were reviewed in a symposium conducted at the 12th annual meeting of the Society of Gastrointestinal Radiologists held recently at Banff, Alberta, Canada. There is a consensus that sonography is the preferred initial screening procedure for bile duct dilatation because of its accuracy and sensitivity although computed tomography more precisely displays the level and cause of obstruction. Transhepatic drainage provides effective decompression for malignant obstruction, but the high rate of postprocedure catheter dysfunction suggests that an indwelling endoprosthesis may be more suitable for short-term palliation. Endoscopic papillotomy has proven to be successful nonoperative therapy for choledocholithiasis and also permits retrograde placement of transpapillary stents. Communication and collaboration among the radiologist, endoscopist, and biliary surgeon are essential if these new methods are to be applied optimally to the various clinical problems encountered with bile duct obstruction.