Intraductal ultrasonography for bile duct microlithiasis / 中华消化内镜杂志

ABSTRACT

Objective To investigate the diagnostic value of intraductal ultrasonography (IDUS) for unconfirmed microlithiasis under endoscopic retrograde cholangiography ( ERC). Methods The data of 22 patients who were definitely diagnosed as having microlithiasis by IDUS and endoscopic sphincterotomy (EST) from July 2007 to September 2009 were retrospectively analyzed. Microlith was defined as choledo-cholith equal to or less than 3 mm in diameter. Using IDUS plus EST findings as golden standard of bile duct microlithiasis, the accuracy of diagnosis and rate of missed diagnosis of transabdominal ultrasonography, magnetic resonance cholangiography (MRC) and ERC were evaluated and compared. Results Diagnosis rates of trans-abdominal ultrasonography, MRC and ERC for extra-hepatic duct microlithiasis were 27. 3% (6/22), 38. 5% (5/13) and 27. 3% (6/22) , respectively. Detection rates of common bile duct dilation by 3 methods were 68. 2% (15/22) , 84. 6% (11/13) and 68. 2% (15/22) , respectively. The microlithiasis in 2 patients, which manifested as repeated acute pancreatitis, were missed by transabdominal ultrasonography , MRC and ERC, and were finally confirmed by IDUS. Conclusion Sensitivity of ERC in diagnosis of extra-hepatic microlithiasis is not superior to that of transabdominal ultrasonography or MRC. IDUS is a technically easy, safe, highly sensitive and accurate procedure, which is helpful in differentiation of etiology of recurrent acute pancreatitis.