Biliary strictures are a challenging problem for the clinician. By the time that patients with biliary strictures are referred to a specialist, the diagnosis is usually already known or strongly suspected because clinical evaluation and nonin- vasive investigations alone have a high specificity and sensitivity. The job of the medical or surgical specialist is not only to confirm the diagnosis of biliary stricture but also, importantly, to define the etiology and the exact anatomic location, which is vital to therapeutic planning. The differentiation between benign and malignant strictures can be difficult but is of obvious importance in regard to prognosis and optimal therapy. Numerous imaging modalities are available for the investigation of biliary strictures, including abdominal ultrasound, computed tomographic (CT) scanning, nuclear imaging, percutaneous transhepatic cholangi- ography (PTC), endoscopic retrograde cholangiopancreatography (ERCP) and most recently magnetic resonance cholangiopancreatography (MRCP). Comparative and descriptive studies in this area are lacking, primarily because rapid technological improvements and developments out- date them. We, therefore, embarked on a prospective descriptive trial with the following aims:
- Determine the predictive value of liver enzymes, serum bilirubin, serum bile acids, ultrasound and diethyl-iminodiacetic acid (Disida) nuclear imaging for the presence of malignant biliary strictures.
- Measure the ability of ultrasound and nuclear imaging to localize the level of obstruction using direct cholangiography as the gold standard.
- Determine the sensitivity of abdominal ultrasound and Disida nuclear scanning for the detection of biliary strictures.
- Investigate the utility of various cholangiographic features to distinguish malignant from benign strictures.
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