Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon and Seoul, Korea.
Dig Dis Sci. 2014 Aug;59(8):1902-8. doi: 10.1007/s10620-014-3127-1. Epub 2014 Jul 10.
Choledocholithiasis is one of the causes of jaundice and may require urgent treatment. Endoscopic retrograde cholangiopancreatography (ERCP) has been the primary management strategy for choledocholithiasis. However, small stones can be overlooked during ERCP.
The aim of this study was to evaluate the accuracy of intraductal ultrasonography (IDUS) for detecting choledocholithiasis in icteric patients with highly suspected common bile duct (CBD) stones without definite stone diagnosis on ERCP.
Ninety-five icteric (bilirubin ≥ 3 mg/dL) patients who underwent ERCP for highly suspected choledocholithiasis without definite filling defects on cholangiography were prospectively enrolled in the present study. We evaluated the bile duct using IDUS for the presence of stones or sludge. Reference standard for choledocholithiasis was endoscopic extraction of stone or sludge.
Bile duct stones were detected with IDUS in 31 of 95 patients (32.6%). IDUS findings were confirmed by endoscopic stone extraction in all patients. The mean diameter of CBD stones detected by IDUS was 2.9 mm (range 1-7 mm). IDUS revealed biliary sludge in 24 patients (25.2%) which was confirmed by sludge extraction in 21 patients (87.5%). In dilated CBD, detection rate of bile duct stone/sludge based on IDUS was significantly higher than in non-dilated CBD (p = 0.004).
IDUS is useful for the detection of occult CBD stone on ERCP in icteric patients with highly suspected CBD stones.
胆总管结石是黄疸的原因之一，可能需要紧急治疗。内镜逆行胰胆管造影（ERCP）一直是胆总管结石的主要治疗策略。然而，ERCP 术中可能会遗漏小结石。
本研究旨在评估经内镜逆行胰胆管造影（ERCP）术中胆管内超声（IDUS）检查对高度怀疑胆总管（CBD）结石但胆管造影未见明确结石的黄疸患者胆总管结石的诊断准确性。
本前瞻性研究纳入了 95 例因高度怀疑胆总管结石而行 ERCP 检查且胆管造影未见明确充盈缺损的黄疸患者。我们使用 IDUS 检查胆管是否存在结石或胆泥。胆总管结石的参考标准为内镜下取石或取胆泥。
在 95 例患者中，31 例（32.6%）通过 IDUS 检测到胆管结石。IDUS 结果在所有患者中均通过内镜取石得到证实。IDUS 检测到的 CBD 结石平均直径为 2.9mm（范围 1-7mm）。IDUS 显示 24 例患者存在胆泥（25.2%），其中 21 例（87.5%）通过取胆泥得到证实。在胆总管扩张的患者中，IDUS 对胆管结石/胆泥的检出率明显高于胆总管不扩张的患者（p=0.004）。
在高度怀疑 CBD 结石的黄疸患者中，ERCP 术中 IDUS 有助于检测隐匿性 CBD 结石。
