Pancreatic-biliary imaging and triage.
The pancreas and biliary tree (and their confluence at the papilla of Vater) are frequent sites for disease. In recent years there has been a proliferation of relevant technologies. Diagnostic methods include percutaneous ultrasound, standard CT scans, helical CT, magnetic resonance imaging, MRCP, endoscopic ultrasound, angiography, ERCP, laparoscopy, and laparoscopic ultrasound. Cytology and biopsy specimens can be taken in conjunction with many of these techniques. In addition to standard open surgical intervention, there are now many alternative therapeutic approaches wielded by endoscopists, interventional radiologists and laparoscopic surgeons. Novel chemotherapy and radiation oncology techniques and further dimensions. Many studies have attempted to evaluate the role of one particular modality, or to compare two diagnostic or therapeutic techniques. It is more important (and more difficult) to devise and test relevant management algorithms. These assessments are bedevilled by the problem of generalizability, since the results of many techniques are operator-dependent. This raises another issue-whether patients with these problems should be managed in regional specialty centers. Another complexity is that the management of a particular problem is influenced not only by the disease and its stage but also by the type of patient in whom it occurs (age, comorbidities, etc.). Multidisciplinary collaboration is a great challenge (12, 13).
Digestive Disease Center, Medical University of South Carolina, Charleston 29425, USA. cottonp@musc.edu
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D000465:Algorithms; D001660:Biliary Tract Diseases / Q000145:classification / Q000175:diagnosis*; D002985:Clinical Protocols; D003952:Diagnostic Imaging; D006801:Humans; D010182:Pancreatic Diseases / Q000145:classification / Q000175:diagnosis*; D014218:Triage