Abstract

Introduction: Cholangiography (ERC) may misdiagnose CBD stones if air bubbles are introduced during contrast injections and it may also fail to diagnose stones in the presence of marked bile duct dilation. Aim:To determine whether IDUS could be a useful adjunct in the management of CBD stones. Methods: IDUS using a wire-guided ultrasound probe(UMG20 29R,Olympus)was performed after initial ERC in patients with suspected CBD stones. The endoscopist noted the probability of CBD stones and sludge (definite, high, intermediate and low) after initial ERC and then noted additional or change in diagnosis after IDUS. Results: ERC with IDUS was performed in 28 patients with suspected CBD stones. CBD stones were confirmed after sphincterotomy and stone extraction in 12 patients. In these 12 patients, ERC classified 5 as definite stones and 5 as high probability. IDUS definitively identified CBD stones in 11 of 12 patients with confirmed CBD stones (PPV 100%, NPV 94%). IDUS confirmed stones in 9 of the 10 patients with high or definite probability ERC. In addition, IDUS identified stones in 1/13 patients classified as intermediate and 1 patient classified as low probability at ERC. Both were confirmed after sphincterotomy and extraction. In addition, IDUS demonstrated air bubbles in 2 patients and subsequent ballooon exploration confirmed the absence of stones. Performance of wire-guided IDUS required a mean of 4.3 ±0.2 minutes. Additional diagnostic information provided by IDUS included identification of cystic duct stones in 3 patients and choledochal varices in 1 patient. Conclusions: IDUS imaging was found to be a useful adjunct to ERC because it helped change management in 4/28 (14%) patients with suspected CBD stones. Specifically, sphincterotomy was performed in 2 patients with IDUS confirmed stones and was avoided in 2 patients with injected air bubbles

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