Original ArticlesWire-guided intraductal US: An adjunct to ERCP in the management of bile duct stones☆,☆☆
Section snippets
Patients and methods
Patients were eligible for inclusion in the study if they were referred for ERC because of a suspicion of choledocholithiasis based on 2 or more of the following: (1) right upper quadrant or epigastric pain, (2) abnormal serum transaminase, serum alkaline phosphatase, and/or total bilirubin, (3) history of acute pancreatitis, (4) recent or ongoing cholangitis, (5) biliary dilatation on transabdominal US and/or CT, and/or (6) bile duct stone and/or sludge diagnosed by US, CT, or ERCP performed
Results
Sixty-two (mean age 64.5 ± 1.3 years, 26 men) patients underwent both ERC and IDUS. Twenty-two patients had undergone cholecystectomy and 26 patients had concomitant cholecystolithiasis. Thirty-four (54.8%) patients had bile duct stones (29 patients) and/or sludge (5 patients) as confirmed by extraction and duodenoscopic visualization. Table 1 shows the comparative performance of ERC alone and ERC plus IDUS in correctly diagnosing the presence of bile duct stone and/or sludge.
Discussion
The role of EUS in the diagnosis of choledocholithiasis has been evaluated in a number of studies.9, 10, 11, 12, 13, 14 The potential advantage to EUS is that it is at least as accurate as ERCP but carries no risk of pancreatitis. However, the inability to perform endoscopic therapy raises questions about the clinical utility of EUS and its place in the diagnostic algorithm for suspected choledocholithiasis.13, 14 This limitation warrants a search for a better modality that uses the capability
References (14)
- et al.
Prospective evaluation of an over-the-wire catheter US probe
Gastrointest Endosc
(2000) - et al.
Characterization of biliary strictures using intraductal ultrasonography: comparison with percutaneous cholangioscopic biopsy
Gastrointest Endosc
(1998) - et al.
Assessment of residual bile duct stones with use of intraductal US during endoscopic balloon sphincteroplasty: comparison with balloon cholangiography
Gastrointest Endosc
(1999) - et al.
Endoscopic ultrasonography versus cholangiography for the diagnosis of choledocholithiasis
Gastrointest Endosc
(1998) - et al.
Endosonography: promising method for diagnosis of extra-hepatic cholestasis
Lancet
(1989) - et al.
Prospective controlled study of endoscopic ultrasonography and endoscopic retrograde cholangiography in patients with suspected common bile duct lithiasis
Lancet
(1996) - et al.
Diagnosis of choledocholithiasis by endoscopic ultrasonography
Gastroenterology
(1994)
Cited by (70)
Advances in Endoscopic Imaging of the Biliary Tree
2019, Gastrointestinal Endoscopy Clinics of North AmericaChapter 29 - Interventional endoscopy: Technical aspects
2016, Blumgart's Surgery of the Liver, Biliary Tract and Pancreas: Sixth EditionCholedocholithiasis: Diagnosis and Management
2015, Techniques in Vascular and Interventional RadiologyCitation Excerpt :Endoscopic retrograde cholangiopancreatography (ERCP) can be used for both diagnosis and treatment of CBD stones. This procedure detects CBD stones with a sensitivity of 80%-93% and a specificity of 100%,12 and with even greater sensitivity if wire-guided intraductal US is performed simultaneously.13 However, patients who undergo ERCP are at risk of developing post-ERCP pancreatitis and cholangitis.
Echoendoscopes
2015, Gastrointestinal EndoscopyThe role of intraductal US in the management of idiopathic recurrent pancreatitis without a definite cause on ERCP
2011, Gastrointestinal EndoscopyThe role of endoscopy in the evaluation of suspected choledocholithiasis
2010, Gastrointestinal Endoscopy
- ☆
Reprint requests: Amitabh Chak, MD, Division of Gastroenterology, 11100 Euclid Ave., Cleveland, OH 44106.
- ☆☆
Gastrointest Endosc 2001;54:31-6