Characterization of biliary strictures using intraductal ultrasonography: comparison with percutaneous cholangioscopic biopsy☆,☆☆,★

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Abstract

Background: We determined the accuracy of intraductal ultrasonography (IDUS) in distinguishing between bile duct cancer and benign bile duct disease. Methods: Patients (n = 42) who required bile duct biopsy using percutaneous transhepatic cholangioscopy (PTCS) to evaluate bile duct strictures or filling defects were studied. A thin-caliber ultrasonic probe (2.0 mm diameter and 20 MHz frequency) was inserted into the bile duct, and its images were prospectively reviewed before PTCS. Results: Disruption of the bile duct wall structure, seen on IDUS, was associated with malignancy in 25 of 26 patients. When IDUS demonstrated a lesion with normal bile duct structure, six of nine patients were found to have no malignancy. IDUS demonstrated no intraductal lesion in seven patients, and bile duct biopsy also did not indicate cancer in any of these patients. The accuracy, sensitivity, and specificity of IDUS for diagnosing bile duct cancer were 76%, 89%, and 50%, respectively. When used in tandem with IDUS, the sensitivity of bile cytology (64%) and PTCS (93%) improved to 96% and 100%, respectively. Conclusions: The accuracy of IDUS for diagnosing bile duct cancer was less than that of PTCS (95%). However, the sensitivity for bile cytology, or bile duct biopsy improved when performed in combination with IDUS. (Gastrointest Endosc 1998;47:341-9.)

Section snippets

Patients

We studied patients in whom cholangiographic findings obtained by endoscopic retrograde cholangiography (ERC) or percutaneous transhepatic biliary drainage (PTBD) suggested bile duct strictures or filling defects. Patients who underwent PTCS were enrolled in the study. Between November 1991 and August 1997, 28 patients who underwent PTCS were found to have evidence of bile duct cancer on either PTCS-guided biopsy specimens or bile cytology. Between November 1991 and August 1995, 14 were found

Complications

No patient required emergency surgery or blood transfusion as a result of PTBD or PTCS, although some patients developed transient abdominal pain (n = 2) or hemobilia (n = 2). One patient suffered acute pancreatitis after transpapillary IDUS that resolved within 48 hours, and required only intravenous fluids and analgesia. This patient had undergone nasobiliary drainage without endoscopic sphincterotomy after completing IDUS. No patient suffered other complications as a result of inserting the

DISCUSSION

IDUS uses a high-frequency (10 MHz or greater) transducer and produces clinically useful images of the bile duct1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 not available with conventional extracorporeal scanning. Essentially, in assessing bile duct lesions by a diagnostic imaging modality, two issues must be addressed. First, differentiating between malignant and benign bile duct disease is essential. Second, when a bile duct lesion is found to be malignant, accurate

Acknowledgements

We thank Hideo Nagai, MD, and Yoshikazu Yasuda, MD, (Department of Surgery) and Nobuyuki Kanai, MD, and Ken Saito (Department of Pathology) for cooperation and advice in this study.

References (39)

  • K Tamada et al.

    Assessment of pancreatic parenchymal invasion by bile duct cancer using intraductal ultrasonography

    Endoscopy

    (1996)
  • K Tamada et al.

    Limitation of intraductal ultrasonography in differentiating between bile duct cancer in stage T1 and stage T2: in vitro and in vivo studies

    Endoscopy

    (1997)
  • K Tamada et al.

    Influence of biliary drainage catheter on bile duct wall thickness as measured by intraductal ultrasonography

    Gastrointest Endosc

    (1998)
  • T Noda et al.

    Transpapillary intraductal ultrasonography (IDUS) of the bile duct without sphincterotomy

    Ultrasound Int

    (1995)
  • K Tokumaru et al.

    A case of anomalous arrangement of the pancreaticobiliary ductal system demonstrated by intraductal ultrasonography

    Am J Gastroenterol

    (1994)
  • M Kuroiwa et al.

    New technique using intraductal ultrasonography for the diagnosis of the bile duct cancer

    Ultrasound Med

    (1994)
  • T Furukawa et al.

    New technique using intraductal ultrasonography for the diagnosis of diseases of the pancreatobiliary system

    Ultrasound Med

    (1992)
  • K Yasuda et al.

    Clinical application of ultrasonic probe in the biliary and pancreatic duct

    Endoscopy

    (1992)
  • CF Engstrom et al.

    Endoluminal ultrasound of the bile ducts

    Surg Endosc

    (1990)

    • Cited by (0)

    ☆

    From the Department of Gastroenterology, Jichi Medical School, Yakushiji, Tochigi, Japan.

    ☆☆

    Reprint requests: Ken Kimura, MD, Department of Gastroenterology, Jichi Medical School, Yakushiji, Tochigi 329-04, Japan.

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    Copyright © 1998 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.