Diagnosis Of Biliary Tract Disease Research Articles

Role of Ultrasonography in Diagnosis of Biliary Tract Diseases: A Single Centre Experience

Role of Ultrasonography in Diagnosis of Biliary Tract Diseases: A Single Centre Experience

Usefulness of contrast-enhanced ultrasonography for biliary tract disease.

Conventional ultrasonography (US) for biliary tract disease shows high time and spatial resolution. In addition, it is simple and minimally invasive, and is selected as a first-choice examination procedure for biliary tract disease. Currently, contrast-enhanced US (CEUS), which facilitates the more accurate assessment of lesion blood flow in comparison with color and power Doppler US, is performed using a second-generation ultrasonic contrast agent. Such agents are stable and provide a timeline for CEUS diagnosis. Gallbladder lesions are classified into three types: gallbladder biliary lesion (GBL), gallbladder polypoid lesion (GPL), and gallbladder wall thickening (GWT). Bile duct lesions can also be classified into three types: bile duct biliary lesion (BBL), bile duct polypoid lesion (BDPL), and bile duct wall thickening (BDWT). CEUS facilitates the differentiation of GBL/BBL from tumorous lesions based on the presence or absence of blood vessels. In the case of GPL, it is important to identify a vascular stalk attached to the lesion. In the case of GWT, the presence or absence of a non-contrast-enhanced area, the Rokitansky-Aschoff sinus, and continuity of a contrast-enhanced gallbladder wall layer are important for differentiation from gallbladder cancer. In the case of BDWT, it is useful to evaluate the contour of the contrast-enhanced medial layer of the bile duct wall for differentiating IgG4-related sclerosing cholangitis from primary sclerosing cholangitis. CEUS for ampullary carcinoma accurately reflects histopathological findings of the lesion. Evaluating blood flow in the lesion, continuity of the gallbladder wall, and contour of the bile duct wall via CEUS provides useful information for the diagnosis of biliary tract disease.

Clinical impact of a novel device delivery system in the diagnosis of bile duct lesions: A single-center experience.

Pathological evaluation is essential for the diagnosis of biliary tract diseases. However, existing evaluation methods have various challenges in terms of operability and diagnostic performance. The present study aimed to evaluate the feasibility, utility, and safety of a novel device delivery system for bile duct biopsy. This study was conducted as a retrospective, descriptive analysis at a single center. Overall, 25 examinations in 14 consecutive patients who underwent transpapillary biopsies for biliary lesions using the novel device delivery system from July to November 2020 were reviewed. Number and time of biopsy, technical success rate, adequate tissue sampling rate, adverse events, and diagnostic performance of bile duct biopsies using the novel device were evaluated. Moreover, negative surgical margins were assessed in patients who underwent surgical resection after mapping biopsy. The median number of biopsy samples was five (range: 2-13), with a median biopsy time of 11.6min. The technical success rate was 100% (140/140), with an adequate sampling rate of 82.9% (116/140). These rates did not differ depending on the biopsy site or purpose. There were no serious adverse events related to the procedures. The diagnostic sensitivity, specificity, and accuracy of biliary stricture were 90%, 100%, and 92.3%, respectively. Negative surgical margins were confirmed in all patients undergoing surgical resection, including one patient with a surgical procedure changed based on the results of mapping biopsy. The novel device delivery system has potentials in diagnosing biliary tract diseases and determining appropriate treatment strategies.

Diagnosis of Biliary Tract Disease Based on Ultrasound Tissue Harmonic Imaging

With the deepening of ultrasound imaging research, studying nonlinear phenomena in medical ultrasound will help people to further improve the existing diagnostic level. Harmonic imaging technology generated in recent years is an effective new technology for nonlinear acoustics in ultrasonic diagnosis. Patients with biliary tract lesions generally have few symptoms, which are often detected by chance during physical examination. Ultrasonography is currently the preferred diagnostic method for biliary tract disease. The application of tissue harmonic imaging (THI) can effectively eliminate many near-field misdiagnosed images, enhance the tissue echo of deep tissues or organs, and significantly improve signal-to-noise ratio and resolution. At the same time, it can better display the subtle features of biliary diseases, thereby reducing the rate of missed diagnosis and improving the accuracy of diagnosis. Therefore, this study aimed to observe the changes of ultrasound images in the lesions and surrounding tissues of several biliary lesions by ultrasound tissue harmonic imaging technology, and realized the diagnosis in the early stage of the disease by means of tissue harmonic imaging technology, then provided objective quantitative indicators for the diagnosis of biliary diseases. Also, this study confirmed that tissue harmonic imaging technology can significantly improve the ultrasound image resolution of biliary tract disease, clearly showing the sub-acute gallbladder wall, gallbladder wall, gallbladder cavity in the acute and chronic inflammation and the presence of subtle changes in the tumor. This can provide a rich diagnostic value for the clinic and has practical significance for clinical treatment.

MODERN TECHNOLOGIES FOR THE DIAGNOSIS OF BILIARY TRACT DISEASES COMPLICATED BY OBSTRUCTIVE JAUNDICE

Summary. Introduction. Diseases of the biliary tract can have a malignant, incendiary and traumatic etiology and be accompanied by a syndrome of obstructive jaundice.
 Objective: to study the effectiveness and specificity of modern technologies for the diagnosis of biliary tract diseases complicated by obstructive jaundice.
 Materials and research methods. We analyzed the instrumental examination of 118 patients with biliary tract diseases complicated by obstructive jaundice.
 Results and its discussion. Ultrasound is the first screening test in the diagnosis of biliary tract diseases. Ultrasound was performed in 74 (62.7 %) patients. The sensitivity of ultrasound as an indicator of biliary tract was 74.3 %. In 74.3 % (55 patients), an ultrasound scan was sufficient to make the correct clinical diagnosis.
 Multispiral computed tomography (MSCT) is an indispensable diagnostic method and method for predicting the volume of surgical intervention for malignant neoplasms of the organs of hepatopancreatic zone. MSCT performed in 59 (50 %) patients.
 The diagnostic accuracy of MSCT for cholangiocarcinoma of various localization was 91.5 %.
 Endoscopic examinations were performed in 31 (26.3 %) patients. Endoscopic retrograde cholangio-pancreatography, based on the results of which, if there are indications for further performance, endoscopic papillosphincterotomy, can be considered the method of choice in the diagnosis and stage-by-stage treatment of obstructive jaundice of gallstone etiology.
 Conclusions. In diseases of the biliary tract, complicated by obstructive jaundice, it is first necessary to perform an ultrasound scan. The highest diagnostic accuracy of ultrasound showed in benign diseases, especially with choledocholithiasis — 94.5 %. In case of insufficient information, MSCT should be used. In the presence of X-ray non-contrast calculi, the use of MSCT is impractical, the sensitivity is 80 %. The highest diagnostic accuracy of MSCT was shown for malignant neoplasms of the urinary tract — 91.5 % and is the method of choice in the diagnosis of the prevalence of tumors and its invasion in adjacent anatomical structures and major vessels.

Bacteriological Profile of Bile in Patients Undergoing Cholecystectomy

Cholecystitis and cholelithiasis are frequently met surgical conditions in North India. The presence of bacteria in bile at the time of surgery or invasive diagnostic procedures predisposes to complications like septicaemia. Aim of this study was to study the bacteriological profile - aerobic & anaerobic in the bile of patients undergoing cholecystectomy. The present study included 50 patients admitted in the department of general surgery undergoing cholecystectomy with preoperative diagnosis of biliary tract disease. Details of the operative findings were recorded. The bile from gallbladder was cultured for the presence of aerobic and anaerobic bacteria. The bacteriological examination of the bile yielded positive culture in 16 out of 50 cases (32%). Aerobic bactobilia was seen in 15 out of 16 patients (93.75%). Anaerobic bactobilia was seen in 4 out of 16 patients (25%). The infection was mostly due to single microorganism. In 9 out of 16 cases (56.25%) the growth was purely aerobic. E.Coli was the most commonly isolated aerobic bacteria (36%).

Advanced Imaging Technology in Biliary Tract Diseases:Narrow-Band Imaging of the Bile Duct.

Newly introduced direct peroral cholangioscopy and the development of video choledochoscopes have enabled more defined observation of bile duct mucosal lesions with clearer images. Narrow-band imaging (NBI) is a unique endoscopic imaging technology that provides enhanced endoscopic images of surface mucosal structures and its superficial microvessels. Advanced cholangioscopy and NBI are expected to be useful for precise evaluation and correct diagnosis of biliary tract diseases. However, the diagnostic value of advanced bile duct imaging with cholangioscopy requires further evaluation.

Cholangioscopy using a new type of cholangioscope for the diagnosis of biliary tract disease: a case series

We present an initial report regarding the clinical usefulness of peroral cholangioscopy, using a new type of cholangioscope, the Polyscope. Peroral cholangioscopy was performed in four patients with strictures after orthotopic liver transplantation (OLT) which were suspected of being ischemic biliary lesions, in three with indeterminate biliary strictures, in three with suspected retained bile duct stones, and in two for evaluation of the intraductal spread of adenomatous tissue after an ampullectomy. In all cases peroral cholangioscopy was performed successfully without complications. On the basis of direct viewing and/or tissue sampling a correct diagnosis was reached in all cases: in all patients who underwent OLT the strictures were not ischemic; the indeterminate strictures were all benign; and, in patients with suspected stones, complete clearance was confirmed. Intraductal spread was confirmed in one patient and excluded in the other. In our experience, peroral cholangioscopy using a Polyscope is a safe and effective method for diagnosing bile duct lesions.

Endoscopic diagnosis of biliary tract disease

Endoscopic diagnosis of biliary disease is challenging due to difficulties in access, visualization, and sampling. Recent advances in endoscopic technology, ancillary diagnostic methods, and our understanding of autoimmune pancreatitis (AIP) and IgG4-related cholangitis (IRC) have led to improvements in the endoscopic diagnosis of pancreaticobiliary disease. Single-operator cholangioscopy overcomes several of the limitations of mother-baby cholangioscopy enhancing the diagnostic accuracy in indeterminate pancreaticobiliary disease. Probe-based confocal laser endomicroscopy has been recently shown to provide a significantly higher accuracy for the diagnosis of malignant biliary strictures than achieved by endoscopic retrograde cholangiopancreatogram and standard tissue acquisition, and has the potential to develop into a useful adjunct method of cholangioscopy. Fluorescence in-situ hybridization increases the sensitivity of routine brush cytology without compromising specificity in patients with indeterminate biliary strictures. The diagnosis of AIP/IRC remains challenging. The recently published international consensus criteria for AIP have included data on the potential diagnostic utility of endoscopic retrograde pancreatogram and endoscopic ampullary biopsies. Recent technical advances as well as ancillary diagnostic methods have improved the diagnostic accuracy of conventional endoscopic techniques. Future refinement of endoscopic methods may further improve diagnostic approaches to biliary disease.

Novel Biopsy Forceps for Diagnosis of Biliary Tract Diseases during Endoscopic Retrograde Cholangiopancreatography: A Prospective Comparative Study with 90° Adjustable and Conventional Biopsy Forceps

Recently, controllable biopsy forceps (MTW, D°sseldorf, Germany) have been developed. This biopsy forceps were 90° adjustable. In the present study, the feasibility and efficacy of the controllable biopsy forceps were compared with those of conventional biopsy forceps in patients with biliary tract disease. A total of 27 patients with biliary tract lesions were enrolled. We evaluated the procedure time, the sample tissue size and the diagnostic accuracy. In addition, the physicians performing the procedure rated their impressions about operability into 3 classes: excellent, fair and poor. The sensitivity in distinguishing benign from malignant lesions was 71.4% (15/21) for the 90° adjustable type and 66.7% (14/21) for the conventional type. The accuracy rate was 77.8% (21/27) for the 90° adjustable type and 74.0% (20/27) for the conventional type. In terms of operability as rated by each physician, the 'excellent' rate was given more frequently to the 90° adjustable type 25.9% than for the conventional type 11.1% (p=0.047). This preliminary study showed that controllable biopsy forceps compared to conventional type biopsy forceps, despite a larger diameter, enables biopsy in a similar procedure time and its ease of use was rated better.

Diagnostic Peroral Video Cholangioscopy Is an Accurate Diagnostic Tool for Patients With Bile Duct Lesions

We evaluated the diagnostic ability of a newly developed peroral video cholangioscopy (PVCS) in patients with pancreaticobiliary disorders. We retrospectively evaluated data from 144 patients with pancreaticobiliary disorders, collected from 5 tertiary referral centers. Endoscopic sphincterotomy (EST) or endoscopic papillary balloon dilation (EPBD) was performed before PVCS. We performed 2 types of PVCS, using a conventional therapeutic duodenoscope. If tissue samples were needed, cholangioscopy-assisted biopsy or fluoroscopy-guided biopsy was performed. PVCS was advanced into the bile duct in all cases after patients received EST (n = 134 cases), EPBD (n = 2), a combination of EST and EPBD (n = 1), or without treatment of the major papilla (n = 7). Biopsy samples were collected successfully from 112 of 120 cases in which endoscopists considered tissue sampling necessary. Endoscopic retrograde cholangiopancreatography (ERCP)/biopsy correctly identified 83 of 96 malignant lesions and 19 of 24 benign lesions (accuracy = 85.0%; sensitivity = 86.5%; specificity = 79.2%; positive predictive value = 94.3%; negative predictive value = 59.4%). Endoscopic retrograde cholangiopancreatography (ERCP)/biopsy plus PVCS correctly identified 95 of 96 malignant lesions and 23 of 24 benign lesions (accuracy = 98.3%; sensitivity = 99.0%; specificity = 95.8%; positive predictive value = 99.0%; negative predictive value = 95.8%). Procedure-related complications included pancreatitis (4 cases, 2.8%) and cholangitis (6 cases, 4.3%). PVCS is an accurate diagnostic tool for patients with pancreaticobiliary disorders; resolution was well-defined when combined with biopsy analysis. Prospective multicenter clinical trials should evaluate the clinical utility of PVCS in diagnosis of biliary tract diseases.

The Successful Use of Peroral Cholangioscopy for the Diagnosis and Treatment of the Biliary Tract Lesions and Giant Bile Duct Stones in a 76-Year-Old Man

We encountered a case in whom peroral cholangioscopy was useful for the diagnosis and treatment of irregular biliary tract mucosa and giant bile duct stones. Peroral cholangioscopy seems to improve the diagnosis of biliary tract diseases and allow internal treatment. The proper diagnosis of biliary tract diseases may be further confirmed by the concomitant use of narrow band imaging and this endoscopic technology.

The clinical significance of common bile-duct dilatation in patients without biliary symptoms or causative lesions on ultrasonography.

Although abdominal ultrasonography (US) is a good initial screening method for detection of biliary tract disease, we sometimes encounter patients who only have findings of dilatation of the common bile duct (CBD) on US, without specific biliary symptoms or jaundice. This study aimed to evaluate the causes and clinical significance of dilatation of the CBD in patients without biliary symptoms, jaundice, or causative lesions at US. A total of 77 patients who had no biliary symptoms and whose internal CBD diameter was more than 7 mm, without definite causative lesions on US, were enrolled. Of these, 49 underwent endoscopic retrograde cholangiopancreatography (ERCP) and 28 underwent follow-up US or computed tomography (CT) instead of ERCP. We excluded patients whose bilirubin level had increased beyond the upper normal level or who had previous history of upper abdominal surgery including cholecystectomy. The ERCP findings were as follows: no lesion in 20 patients (40.8%), juxtapapillary duodenal diverticulum (JDD) in 11 (22.5%), benign stricture in ten (20.4%), distal CBD mass in two (4.1%), choledochal cyst in two (4.1%), anomalous union of the pancreaticobiliary duct (AUPBD) in two (4.1%), and choledochal cyst with AUPBD in two (4.1%). There were no differences in age or in alkaline phosphatase or gamma-glutamyl transpeptidase (GGT) levels between the patients who had causative lesions revealed at ERCP and those who did not. Among the 28 patients who did not undergo ERCP, 12 had returned to normal and eight had no change in CBD diameter on follow-up US. Among eight patients who underwent CT, there were four with normal findings, one with JDD, and three with suspected choledochal cysts. We detected a significant number of causative biliary tract lesions in asymptomatic adults with dilatation of the CBD on routine abdominal US; no laboratory or demographic parameters were useful for discrimination. Further diagnostic study will be helpful for the early diagnosis of biliary tract disease in such patients.

Clinacal efficacy of magnetic resonance cholangiopancreatography in the diagnosis of biliary tract diseases

Clinacal efficacy of magnetic resonance cholangiopancreatography in the diagnosis of biliary tract diseases

High‐frequency Intraductal Ultrasound Images of Biliary Tract Lesions: Experimental Studies

Abstract: To investigate the differences in images obtained with a 3.75 MHz, 7.5 MHz or 20 MHz transducer, 27 stones, five debris samples, and three cholesterol polyps were examined in a water tank. All stones showed definite acoustic shadowing on images produced with the 20 MHz transducer, although the acoustic shadowing was weak or absent on images produced by 3.75 MHz or 7.5 MHz transducers. Regarding the relation between stone size and the acoustic shadowing, this shadowing was visualized for stones as small as 1.5 mm when the 20 MHz transducer was used. The hyperechoic appearance changed to a sharp crescent shape with the high frequency transducer. Images of cholesterol polyps and debris produced by the 20 MHz transducer showed no fundamental differences when compared with conventional ultrasonographic images obtained with a 3.75 MHz transducer, and there was no accompanying acoustic shadowing. In conclusion, ultrasonic images obtained with high frequency transducers which are used in intraductal ultrasound are different from those produced with conventional ultrasound probes. These phenomena may be useful for differential diagnosis of biliary tract diseases.

Magnetic resonance cholangiography: Comparison with endoscopic retrograde cholangiopancreatography

BACKGROUND & AIMS: Magnetic resonance cholangiography (MRC) is a noninvasive diagnostic modality capable of producing high-quality images of the biliary tree. The purpose of this study was to determine in a prospective, blinded fashion the sensitivity and specificity of three-dimensional fast spin-echo (3D FSE) MRC for the evaluation of biliary tract abnormalities. METHODS: Forty-six patients referred for elective direct cholangiography (45 endoscopic retrograde cholangiopancreatography and 1 percutaneous transhepatic cholangiography) were studied prospectively with 3D FSE MRC during a 1- year period. All images were interpreted blindly by two radiologists. The presence of dilatation, strictures, and intraductal abnormalities was recorded. Sensitivity and specificity of 3D FSE MRC were determined using findings on direct cholangiography as the gold standard. RESULTS: MRC images of diagnostic quality were obtained in 44 (95.7%) of the patients. Sensitivity for the detection of bile duct dilatation (n = 27), biliary strictures (n = 10), and intraductal abnormalities (n = 7) was 96.3%, 90%, and 100%, respectively. In addition, the MRC showed 16 of 17 patients with normal bile ducts (specificity, 94.1%). CONCLUSIONS: MRC has a very high sensitivity and specificity in the evaluation of the biliary tract. Based on these data, we believe that the efficacy of MRC using 3D FSE is sufficient to warrant its use in the routine diagnosis of biliary tract disease. (Gastroenterology 1996 Feb;110(2):589-97)

Revised Estimates of Diagnostic Test Sensitivity and Specificity in Suspected Biliary Tract Disease

The purpose of this study was to estimate the sensitivity and specificity of diagnostic tests for gallstones and acute cholecystitis. All English-language articles published from 1966 through 1992 about tests used in the diagnosis of biliary tract disease were identified through MEDLINE. From 1614 titles, 666 abstracts were examined and 322 articles were read to identify 61 articles with information about sensitivity and specificity. Application of exclusion criteria based on clinical and methodologic criteria left 30 articles for analysis. Cluster-sampling methods were adapted to obtain combined estimates of sensitivities and specificities. Adjustments were made to estimates that were biased because the gold standard was applied preferentially to patients with positive test results. Ultrasound has the best unadjusted sensitivity (0.97; 95% confidence interval, 0.95 to 0.99) and specificity (0.95; 95% confidence interval, 0.88 to 1.00) for evaluating patients with suspected gallstones. Adjusted values are 0.84 (0.76 to 0.92) and 0.99 (0.97 to 1.00), respectively. Adjusted and unadjusted results for oral cholecystogram were lower. Radionuclide scanning has the best sensitivity (0.97; 95% confidence interval, 0.96 to 0.98) and specificity (0.90; 95% confidence interval, 0.86 to 0.95) for evaluating patients with suspected acute cholecystitis; test performance is unaffected by delayed imaging. Unadjusted sensitivity and specificity of ultrasound in evaluating patients with suspected acute cholecystitis are 0.94 (0.92 to 0.96) and 0.78 (0.61 to 0.96); adjusted values are 0.88 (0.74 to 1.00) and 0.80 (0.62 to 0.98). Ultrasound is superior to oral cholecystogram for diagnosing cholelithiasis, and radionuclide scanning is the test of choice for acute cholecystitis. However, sensitivities and specificities are somewhat lower than commonly reported. We recommend estimates that are midway between the adjusted and unadjusted values.

Granular Cell Tumor of the Biliary Tree

Granular cell tumors are relatively uncommon soft tissue tumors usually presenting in the skin and subcutaneous tissues or tongue, although many sites have been described. Two cases arising in the extrahepatic biliary tree are described, and the previously reported cases of this rare presentation are reviewed. These tumors may mimic sclerosing cholangitis and cholangiocarcinoma clinically, and occasionally histologically, in this relatively young group of patients. The histogenesis appears to be related to Schwann cells as in granular cell tumors of other sites, evidenced by histologic, immunohistochemical, and electron microscopic findings. Granular cell tumors, albeit rare, should be considered in the differential diagnosis of biliary tract disease in young patients, particularly black women, and are curable by surgical excision.

Efficacy of plain abdominal radiography in patients with biliary tract disease

A retrospective review was performed to determine the usefulness of plain abdominal radiographs in patients presenting to the emergency department with gallbladder disease. Patients with the clinical diagnosis of biliary tract disease were divided into two groups: those with confirmed biliary tract disease and those who did not have gall bladder disease. There were no major radiologic findings (pneumoperitoneum, pneumobilia, or bowel obstruction) in any patient with biliary tract disease. No significant difference was noted in the incidence of minor radiologic findings (right upper quadrant calcification, mild ileus and right basilar atelectasis) in patients with biliary colic and acute cholecystitis. Additionally, there was no significant difference in minor findings between patients with biliary tract and nonbiliary tract disease. Plain abdominal radiographic findings were found to be nonspecific in patients with gallbladder disease and not useful in differentiating between patients with biliary colic and acute cholecystitis. Our results also suggest that plain abdominal radiographic findings are not useful in differentiating between patients with and without biliary tract disease, although the selection of patients without biliary tract disease may have biased this finding.

Cholangitis due to Blastomyces dermatitidis

A 70-yr-old woman presented with nonspecific complaints and had findings of a cholestatic liver enzyme pattern and a dilated left intrahepatic ductal system by radiographic imaging. Endoscopic retrograde cholangiopancreatography revealed multiple irregular flat stones and a fixed filling defect of the left hepatic duct. At the time of surgery a stonelike lesion of this ductal orifice was found along with a miliary pattern of infection of the left liver lobe. Histologic and microbiologic studies confirmed an infection by Blastomyces dermatitidis. Therapy with amphotericin B resulted in eradication of this infection. Despite their rarity, fungal infections of the biliary tree need to be considered in the differential diagnosis of biliary tract disease in the elderly and immunocompromised patient.