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Usefulness of Intraductal Ultrasonography in Icteric Patients with Highly Suspected Choledocholithiasis Showing Normal Endoscopic Retrograde Cholangiopancreatography

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Abstract

Background

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.

Aim

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.

Methods

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.

Result

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).

Conclusion

IDUS is useful for the detection of occult CBD stone on ERCP in icteric patients with highly suspected CBD stones.

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Abbreviations

ERCP:

Endoscopic retrograde cholangiopancreatography

IDUS:

Intraductal ultrasonography

CBD:

Common bile duct

EST:

Endoscopic sphincterotomy

EUS:

Endoscopic ultrasonography

CT:

Computed tomography

MRCP:

Magnetic resonance cholangiopancreatography

US:

Ultrasonography

GB:

Gallbladder

SD:

Standard deviation

PPV:

Positive predictive value

NPV:

Negative predictive value

CI:

Confidence interval

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Acknowledgments

This work was supported by the SoonChunHyang University Research Fund. We thank A Ri Song, RN; Song Ah Jeong, RN; Sun Yeong Moon, RN; and the entire nursing staff for their support and assistance with the procedures.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon and Seoul, Korea

    Dong Choon Kim, Jong Ho Moon, Hyun Jong Choi, A Reum Chun, Yun Nah Lee, Tae Hoon Lee, Sang Woo Cha, Sang Gyune Kim, Young Seok Kim, Young Deok Cho & Sang-Heum Park

  2. Department of Radiology, SoonChunHyang University School of Medicine, Bucheon, Korea

    Min Hee Lee & Hae Kyung Lee

  3. Digestive Disease Center and Research Institute, SoonChunHyang University Bucheon Hospital, 1174 Jung-Dong, Wonmi-Ku, Bucheon, 420-767, Korea

    Jong Ho Moon

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  1. Dong Choon Kim
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  2. Jong Ho Moon
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  3. Hyun Jong Choi
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  9. Sang Gyune Kim
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Corresponding author

Correspondence to Jong Ho Moon.

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Kim, D.C., Moon, J.H., Choi, H.J. et al. Usefulness of Intraductal Ultrasonography in Icteric Patients with Highly Suspected Choledocholithiasis Showing Normal Endoscopic Retrograde Cholangiopancreatography. Dig Dis Sci 59, 1902–1908 (2014). https://doi.org/10.1007/s10620-014-3127-1

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  • DOI: https://doi.org/10.1007/s10620-014-3127-1

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