Diseases of the Gallbladder and Bile Ducts: Diagnosis and Treatment

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9780632044788: Diseases of the Gallbladder and Bile Ducts: Diagnosis and Treatment
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Diseases of the Gallbladder and Bile Ducts is the only book available that addresses modern methods of diagnosing and treating the most common to the most complex gallbladder and biliary diseases. Using a multidisciplinary author team, this book serves the needs of all those involved in the management of patients--from medical students to specialists in gastroenterology, surgery and radiology.

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Diseases of the Gallbladder and Bile Ducts is the only book available that addresses modern methods of diagnosing and treating the most common to the most complex gallbladder and biliary diseases. Using a multidisciplinary author team, this book serves the needs of all those involved in the management of patients--from medical students to specialists in gastroenterology, surgery and radiology. This concise and timely reference features:


  • More that 200 illustrations

  • Editorial team from a leading hospital

  • Anatomy, physiology, and imaging plus differential diagnosis and treatment options

  • The latest therapeutic modalities ranging from mini-invasive procedures such as endoscopic or laparoscopic procedures to new techniques of liver transplantation

From The New England Journal of Medicine:

The treatment of diseases of the gallbladder and bile ducts has changed a great deal over the past dozen years. By 1990, extracorporeal lithotripsy of gallstones and various methods of dissolving gallstones threatened in part to replace cholecystectomy. Laparoscopic cholecystectomy was a novelty then but is now the usual treatment for symptomatic gallbladder stones. Now dissolution of gallstones and extracorporeal lithotripsy are practically curiosities. Endoscopic ultrasonography and magnetic resonance imaging are replacing endoscopic cholangiography in some instances. There is a growing understanding of the molecular biology of bile flow and biliary diseases. Unfortunately, biliary cancers continue to carry a grave prognosis, and there is no definitive treatment other than liver transplantation for primary biliary cirrhosis or sclerosing cholangitis. A variety of atlases, symposium proceedings, and textbooks on liver disease cover this area from their own particular perspectives. This multiauthored reference fulfills the need for an up-to-date clinical textbook covering the entire field of biliary disease. The editors are well known in the fields of hepatobiliary surgery and biliary endoscopy. Half of the 36 authors are drawn from the faculty of Duke University, and the remainder are prominent members of other faculties in the United States and abroad. The first section of the book includes chapters on anatomy, pathology, and noninvasive radiology of the biliary system. Standard, noninvasive methods of imaging are discussed, in addition to magnetic resonance imaging, which has recently begun to be used for the imaging of bile ducts. The chapter on endoscopic diagnosis and treatment offers a side-by-side comparison of endoscopic ultrasonography and endoscopic cholangiography. Endoscopic ultrasonography may become the preferred method of checking for common-bile-duct stones in patients who are considered to be at low risk for them. Endoscopic ultrasonography is also useful in identifying small gallbladder stones in selected patients and in characterizing small masses in the wall of the gallbladder. If they are smaller than 5 mm, such masses usually represent an accumulation of cholesterol in the mucosa, but larger masses sometimes represent neoplasms. Endoscopic ultrasonography can eliminate the common problem of whether to continue sonographic follow-up indefinitely or to perform a cholecystectomy. Percutaneous transhepatic cholangiography and therapy for biliary obstruction are discussed in two detailed chapters, with numerous illustrations. The pathophysiology of gallstone formation is discussed relatively briefly, in keeping with the clinical focus. After chapters on cholecystitis and cholangitis, there is a chapter devoted to Mirizzi's syndrome, which involves compression of the common bile duct by a stone in the neck of the gallbladder, sometimes with a cholecysto-choledochal fistula. Therapies that dissolve gallstones and extracorporeal lithotripsy are given no more than a page between them, indicating their diminished importance in practice. Despite advances in imaging of the gallbladder, it often remains difficult to know whether gallstones are causing pain in a given patient. It is also unclear why some patients without gallstones have low gallbladder ejection fraction and pain that is relieved by cholecystectomy. From a surgeon's perspective, this book would not substitute for a comprehensive surgical textbook or atlas. Laparoscopic cholecystectomy is described on one page. However, surgery of the bile ducts is discussed in a great deal of technical detail, as are laparoscopic procedures for cholangiography, bile-duct exploration, and ultrasonography. Separate chapters cover surgical injuries to the bile duct (emphasizing their prevention) and bile-duct complications of liver transplantation. There is extensive coverage of the various methods for treating cancers of the gallbladder and bile ducts. Curative surgery is often impossible, the value of external-beam radiotherapy and radioactive implants is uncertain, and chemotherapy is primarily palliative. Novel gene therapies and antiangiogenesis treatments are under investigation. Palliative treatment of malignant biliary obstruction has advanced over the past decade with use of expandable metal stents, which can be placed either endoscopically or by the percutaneous transhepatic route. The book concludes with excellent reviews of the principal cholestatic liver diseases: sclerosing cholangitis, primary biliary cirrhosis, cystic diseases of the liver and bile ducts, and biliary atresia and other cholestatic diseases that affect children. Although this book is clinically oriented, it contains an excellent chapter on intrahepatic cholestasis, including a discussion of the molecular biology of bile secretion and cholestasis. The book was carefully edited to ensure consistency of presentation and to minimize duplication of subject matter between chapters. I found only a few scattered, minor misstatements. It is illustrated with more than 70 tables and 200 black-and-white figures, including many imaging studies. The most similar book published within the past five years is Gallbladder and Biliary Disease, a multiauthored book edited by Afdahl (New York: Marcel Dekker, 2000). Alternatively, one could turn to the third edition of Surgery of the Liver and Biliary Tract, edited by Blumgart and Fong (Philadelphia: W.B. Saunders, 2000). Both these books cover similar topics in more than twice as many pages of text, but they sell for about $250 and $450, respectively. The Clavien and Baillie textbook is an excellent, up-to-date, moderately priced reference for physicians and surgeons with a major interest in the diagnosis and treatment of diseases of the biliary tract. David E. Johnston, M.D.
Copyright © 2002 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

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Pierre-Alain Clavien (Editor), John Baillie (Editor)
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