BILIARY SURGERY WITHOUT THE SURGEON

Since the introduction of endoscopic retrograde cholangiopancreatograp hy in the 1970s and of endoscopic sphincterotomy (EST) in 1974, endosc opic techniques for the diagnosis and therapy of biliary and pancreati c disorders have proliferated. Although some procedures have become pa rt of routine practice, for example EST for postcholecystectomy bile d uct stones and stent insertion for inoperable biliary strictures, the place of others is unclear at present and should be evaluated by prosp ective randomized clinical trials. The choice of either an endoscopic or a transhepatic approach for biliary disease is usually dictated by local expertise, but these should be regarded as complementary rather than competing techniques, and complex biliary problems should be mana ged jointly by the endoscopist, interventional radiologist and hepatob iliary surgeon.