Abstract
Objectives To investigate the diagnostic value of contrast-enhanced ultrasound- (CEUS-) guided contrast injection via an endoscopic nasobiliary drainage (ENBD) tube on the evaluation for residual stones in common bile duct (CBD). Methods 116 patients with CBD stones were treated by endoscopic retrograde cholangiopancreatography and duodenoscopic sphincterotomy incision surgery and ENBD. The US group consisted of 54 patients who underwent US-guided saline injection via the ENBD tube to evaluate for residual CBD stones. The CEUS group consisted of 62 patients who underwent CEUS-guided contrast injection via the ENBD tube to evaluate for residual CBD stones. The length and width of CBD and the detection rate of residual stones before and after NS injection were compared. Results In both the US group and the CEUS group, the rate of complete demonstration and the average length and width of CBD before and after injection of NS were all increased significantly. In the US group, 6 patients had verified residual stones, 1 of which was detected by conventional US (detection rate, 1/6), 5 of which were detected by saline injection ultrasound (detection rate, 5/6), and 4 of which were detected by ENBD cholangiography (detection rate, 4/6). There was 1 false positive result on saline injection US and 2 false positives on ENBD cholangiography. In the CEUS group, 6 patients had verified residual stones, none of which were detected by conventional US (detection rate, 0/6), all of which were detected by saline injection CEUS (detection rate, 6/6), and 4 of which were detected by ENBD cholangiography (detection rate, 4/6). There was 1 false positive result on ENBD cholangiography. Conclusions CEUS-guided contrast injection via an ENBD tube helps to provide clear observation of residual stones in the CBD after ERCP with EST and provides comprehensive information for follow-up.
Highlights
Gallstones are common and affect 10–15% of the adult population
The CEUS group consisted of 62 patients who underwent CEUSguided contrast injection via the endoscopic nasobiliary drainage (ENBD) tube to evaluate for residual common bile duct (CBD) stones between February 2016 and December 2016
Six patients had verified residual stones, 1 of which was detected by conventional US, 5 of which were detected by saline injection ultrasound, and 4 of which were detected by ENBD cholangiography
Summary
Gallstones are common and affect 10–15% of the adult population. Some 4% of these patients become symptomatic each year, with biliary colics, cholecystitis, or cholangitis [1]. There are currently 2 widely accepted treatment strategies for patients presenting to the hospital with choledocholithiasis, including endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic exploration of the common bile duct (CBD) [2]. ERCP provided a less invasive method for treating choledocholithiasis. With improvements in endoscopic technology and instruments, ERCP with endoscopic sphincterotomy (EST) has gradually become the mainstream method of treatment [3]. Cotton et al [4] were the first to use an endoscopic nasobiliary drainage (ENBD) catheter for several days in the common bile duct (CBD) after endoscopic sphincterotomy (EST). ENBD placement provides reliable biliary drainage and perfusion and allows for cholangiography. ENBD reduces the need for instrumental stone extraction and repeated endoscopy and transnasal cholangiography to assess whether the stones have been fully cleared [5]. In subsequent studies [6,7,8,9,10], it was found that EST or endoscopic papillary balloon dilatation (EPBD) followed
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