Investigation and management of biliary tract disease

Evolution in the diagnosis and non-surgical management of biliary tract disease is outlined and analyzed. The relative roles of endoscopic and percutaneous techniques are weighed in terms of risk, technical difficulty and clinical value. Initial diagnosis and treatment should be by endoscopic retrograde cholangiopancreatography (ERCP) when feasible because of lower diagnostic and treatment risk. When technical or clinical circumstances dictate, a prompt shift to percutaneous techniques is indicated. The complimentary roles of endoscopic, percutaneous and surgical methods are emphasized. Therapy by nonsurgical methods is closely linked to diagnosis by direct cholangiography. Close coordination reduces hazard and improves likelihood of successful resolution in these difficult clinical problems.