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News

Clinical utility of intraductal US for evaluation of choledocholithiasis

Researchers, in the May issue of Gastrointestinal Endoscopy, report that selective use of intraductal US alters the clinical management in a proportion of patients who have undergone ERCP for suspected bile duct stones.

News image

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Intraductal US can improve the diagnostic accuracy of cholangiography performed under C-arm fluoroscopy in patients with suspected choledocholithiasis.

In this study, researchers from the United States determined the clinical utility of intraductal US for patient management.

Intraductal US led to a change in clinical management in 37% of patients.
Gastrointestinal Endoscopy

The research team assessed 52 patients, with suspected choledocholithiasis, undergoing ERCP with a C-arm fluoroscope at 2 tertiary academic medical centers.

After initial cholangiography, the team recorded the findings and decisions concerning the need for further intervention.

The team then selectively performed intraductal US (20 MHz) in 35 patients with equivocal cholangiography and those without cholangiographic evidence of bile duct stones.

Intraductal US was also performed after endoscopic sphincterotomy and stone extraction to confirm bile duct clearance.

The researchers found that of the 21 patients with normal cholangiography, 38% had stones or sludge by intraductal US. The team performed endoscopic sphincterotomy as a direct result of intraductal US in these patients, and the findings were confirmed in all but one.

However, in the 14 patients in whom cholangiography demonstrated small (< 5 mm) or round filling defects, intraductal US concurred in 9 and found air bubbles or no stone in 5. Sphincterotomy was avoided in these 5 patients.

Overall, the team determined that intraductal US led to a change in clinical management in 37% of patients.

Dr Andrew Catanzaro's team concluded, "Selective use of intraductal US affects the clinical management of a large proportion of patients who undergo C-arm fluoroscopy-guided ERCP for suspected bile duct stones".

Gastrointest Endosc 2003; 57(6): 648-52
25 April 2003

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