Intraductal Ultrasonography Without Radiocontrast Cholangiogramin Patients with Extrahepatic Biliary Disease

Overview

Journal Gut Liver

Specialty Gastroenterology

Date 2015 May 13

PMID 25963077

Citations 4

Authors

Sung-Uk Lim

Chang-Hwan Park

Won-Ju Kee

Jeong-Hyun Lee

Soo-Jung Rew

Seon-Young Park

Hyun-Soo Kim

Sung-Kyu Choi

Jong-Sun Rew

Affiliations

Soon will be listed here.

Abstract

Background/aims: Intraductal ultrasonography (IDUS) has been performed as an adjunct to endoscopic retrograde cholangiography (ERC) during radiocontrast cholangiography (RC). Radiation exposure during RC poses a health risk to both patients and examiners. We evaluated the feasibility of IDUS without RC in various extrahepatic biliary diseases.

Methods: IDUS was performed with the insertion of an IDUS probe from the papilla of Vater to the confluent portion of the common hepatic duct without fluoroscopy. The technical success rate and procedure-related complications were evaluated retrospectively.

Results: Wire-guided IDUS without RC was performed in 105 patients. The mean age was 66.5 years, and 50 (47.6%) were male. The IDUS diagnoses included choledocholithiasis (73, 69.5%), benign biliary stricture (11, 10.5%), choledocholithiasis with biliary pancreatitis (9, 8.6%), bile duct cancer (5, 4.8%), pancreatic cancer (1, 0.9%), and others (6, 5.7%). After IDUS, 66 (62.8%) underwent stone removal, 19 (18.1%) underwent biliary drainage, and 7 (6.6%) underwent brush cytology and biopsy. No significant complications such as perforation or severe pancreatitis occurred.

Conclusions: IDUS without RC was a feasible and safe approach in patients with various extrahepatic biliary diseases. We anticipate a potentially important role of IDUS in various ERC procedures because it lacks the hazards of RC.

Citing Articles

The Endoscopic Retrograde Cholangiopancreatography and Endoscopic Ultrasound Connection: Unity Is Strength, or the Endoscopic Ultrasonography Retrograde Cholangiopancreatography Concept.

De Angelis C, DallAmico E, Staiano M, Gesualdo M, Bruno M, Gaia S Diagnostics (Basel). 2023; 13(20).

PMID: 37892086 PMC: 10606726. DOI: 10.3390/diagnostics13203265.

Biliary Tree Diagnostics: Advances in Endoscopic Imaging and Tissue Sampling.

Ghisa M, Bellumat A, De Bona M, Valiante F, Tollardo M, Riguccio G Medicina (Kaunas). 2022; 58(1).

PMID: 35056443 PMC: 8781810. DOI: 10.3390/medicina58010135.

The role of intraductal ultrasonography in pancreatobiliary diseases.

Sun B, Hu B Endosc Ultrasound. 2016; 5(5):291-299.

PMID: 27803901 PMC: 5070286. DOI: 10.4103/2303-9027.191607.

Comparison of intraductal ultrasonography-directed and cholangiography-directed endoscopic retrograde biliary drainage in patients with a biliary obstruction.

Rew S, Lee D, Park C, Jeon J, Kim H, Choi S Korean J Intern Med. 2016; 31(5):872-9.

PMID: 27097771 PMC: 5016288. DOI: 10.3904/kjim.2015.291.

References

Tamada K, Inui K, Menzel J . Intraductal ultrasonography of the bile duct system. Endoscopy. 2001; 33(10):878-85. DOI: 10.1055/s-2004-814512. View

Menzel J, Poremba C, Dietl K, Domschke W . Preoperative diagnosis of bile duct strictures--comparison of intraductal ultrasonography with conventional endosonography. Scand J Gastroenterol. 2000; 35(1):77-82. DOI: 10.1080/003655200750024579. View

Jha R, Al-Kawas F . How good is IDUS in patients with isolated biliary strictures?. Am J Gastroenterol. 2004; 99(9):1690-1. DOI: 10.1111/j.1572-0241.2004.40628.x. View

Cotton P, Lehman G, Vennes J, GEENEN J, Russell R, Meyers W . Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991; 37(3):383-93. DOI: 10.1016/s0016-5107(91)70740-2. View

Ascher S, Evans S, Goldberg J, Garra B, Benjamin S, Davros W . Intraoperative bile duct sonography during laparoscopic cholecystectomy: experience with a 12.5-MHz catheter-based US probe. Radiology. 1992; 185(2):493-6. DOI: 10.1148/radiology.185.2.1410361. View

Rahmin M, Hitscherich R, Jacobson I . ERCP for symptomatic choledocholithiasis in pregnancy. Am J Gastroenterol. 1994; 89(9):1601-2. View

Stavropoulos S, Larghi A, Verna E, Stevens P . Therapeutic endoscopic retrograde cholangiopancreatography without fluoroscopy in four critically ill patients using wire-guided intraductal ultrasound. Endoscopy. 2005; 37(4):389-92. DOI: 10.1055/s-2005-861118. View

Stavropoulos S, Larghi A, Verna E, Battezzati P, Stevens P . Intraductal ultrasound for the evaluation of patients with biliary strictures and no abdominal mass on computed tomography. Endoscopy. 2005; 37(8):715-21. DOI: 10.1055/s-2005-870132. View

Shelton J, Linder J, Rivera-Alsina M, Tarnasky P . Commitment, confirmation, and clearance: new techniques for nonradiation ERCP during pregnancy (with videos). Gastrointest Endosc. 2008; 67(2):364-8. DOI: 10.1016/j.gie.2007.09.036. View

10.

Artifon E, Kumar A, Eloubeidi M, Chu A, Halwan B, Sakai P . Prospective randomized trial of EUS versus ERCP-guided common bile duct stone removal: an interim report (with video). Gastrointest Endosc. 2009; 69(2):238-43. DOI: 10.1016/j.gie.2008.05.020. View

11.

Chak A, Isenberg G, Kobayashi K, Wong R, Sivak Jr M . Prospective evaluation of an over-the-wire catheter US probe. Gastrointest Endosc. 2000; 51(2):202-5. DOI: 10.1016/s0016-5107(00)70419-6. View

12.

Weigt J, Kandulski A, Malfertheiner P . Direct peroral cholangioscopy using ultraslim gastroscopes: high technical performance with important diagnostic yield. Gastrointest Endosc. 2013; 79(1):173-7. DOI: 10.1016/j.gie.2013.07.011. View

13.

Menzel J, Domschke W . Gastrointestinal miniprobe sonography: the current status. Am J Gastroenterol. 2000; 95(3):605-16. DOI: 10.1111/j.1572-0241.2000.01832.x. View

14.

Draganov P, Cotton P . Iodinated contrast sensitivity in ERCP. Am J Gastroenterol. 2000; 95(6):1398-401. DOI: 10.1111/j.1572-0241.2000.02069.x. View

15.

Wang H, Huang S, Sun M, Chen J, Wang H, Lin C . Urgent endoscopic nasobiliary drainage without fluoroscopic guidance: A useful treatment for critically ill patients with biliary obstruction. Gastrointest Endosc. 2000; 52(6):741-4. DOI: 10.1067/mge.2000.109800. View

16.

Ang T, Teo E, Fock K, Tan J . Are there roles for intraductal US and saline solution irrigation in ensuring complete clearance of common bile duct stones?. Gastrointest Endosc. 2009; 69(7):1276-81. DOI: 10.1016/j.gie.2008.10.018. View

17.

Akcakaya A, Ozkan O, Okan I, Kocaman O, Sahin M . Endoscopic retrograde cholangiopancreatography during pregnancy without radiation. World J Gastroenterol. 2009; 15(29):3649-52. PMC: 2721239. DOI: 10.3748/wjg.15.3649. View

18.

Jorgensen J, Rubenstein J, Goodsitt M, Elta G . Radiation doses to ERCP patients are significantly lower with experienced endoscopists. Gastrointest Endosc. 2010; 72(1):58-65. PMC: 2906113. DOI: 10.1016/j.gie.2009.12.060. View

19.

Itoi T, Moon J, Waxman I . Current status of direct peroral cholangioscopy. Dig Endosc. 2011; 23 Suppl 1:154-7. DOI: 10.1111/j.1443-1661.2011.01114.x. View

20.

Pohl J, Ell C . Direct transnasal cholangioscopy with ultraslim endoscopes: a one-step intraductal balloon-guided approach. Gastrointest Endosc. 2011; 74(2):309-16. DOI: 10.1016/j.gie.2011.02.022. View