Approach to Cholestasis

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Abstract
• New techniques have changed the approach to diagnosis and therapy in the patient with cholestasis. Screening with ultrasonography or computed tomographic scanning, followed by direct opacification of the biliary tree by percutaneous transhepatic cholangiography (PTC) or endoscopic retrograde cholangiopancreatography (ERCP) provides accurate diagnostic information. Therapeutic extensions of PTC and ERCP permit decompression of obstructed biliary systems either as an aid to preoperative management or for longterm decompression in operable patients. Thus, the role of surgery in cholestasis can now be more strictly defined. (Arch Intern Med 1982;142:1877-1879)