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Catheter probe extraductal ultrasound (EDUS) exploration of the common bile duct is safe in elderly patients with suspicion of choledocholithiasis after distal gastrectomy

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Abstract

Purpose

Post-surgical upper gastrointestinal anatomy may hamper a complete bilio-pancreatic evaluation with a standard echoendoscope. The aim of this study was to assess the role of catheter probe extraductal ultrasound (EDUS) for the evaluation of the common bile duct (CBD) in patients who are status post-gastric surgery and who are suspected of having choledocholithiasis.

Methods

We retrospectively analyzed patients with a prior history of gastric surgery, who underwent EDUS for a suspicion of CBD obstruction. For each patient, technical success, accuracy, and safety were recorded. In case of a positive finding of CBD stones, endoscopic retrograde cholangiopancreatography (ERCP) was performed. In case of other findings or a negative EDUS, computed tomography or magnetic resonance cholangiopancreatography (MRCP) was performed as appropriate.

Results

EDUS was technically successful in all the 11 patients with a Billroth II gastrectomy, while it failed in all the 5 patients with Roux-en-Y gastric surgery. EDUS accuracy was 100% (3 true-positive and 8 true-negative cases). CBD stones, confirmed and successfully extracted at ERCP, were found in two patients, while in one patient EDUS showed a CBD stenosis that was treated with a plastic stent during ERCP; computed tomography at follow-up was negative for cancer. EDUS was correctly negative in 8 patients, as confirmed by MRCP.

Conclusions

EDUS may represent an accurate and safe alternative to standard endoscopic ultrasonography and MRCP for the detection of CBD stones in elderly patients who are status post-Billroth II gastric surgery.

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Authors and Affiliations

  1. Endoscopy Unit, Department of Surgical Sciences, Hospital of Mantova, Strada Lago Paiolo, 10, 46100, Mantua, Italy

    Thomas Togliani & Stefano Pilati

  2. Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Bologna, Hospital of Imola, Imola, Italy

    Andrea Lisotti, Giancarlo Caletti & Pietro Fusaroli

Authors
  1. Thomas Togliani
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  2. Stefano Pilati
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  3. Andrea Lisotti
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  4. Giancarlo Caletti
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  5. Pietro Fusaroli
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Corresponding author

Correspondence to Thomas Togliani.

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The authors declare that they have no conflict of interest.

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Togliani, T., Pilati, S., Lisotti, A. et al. Catheter probe extraductal ultrasound (EDUS) exploration of the common bile duct is safe in elderly patients with suspicion of choledocholithiasis after distal gastrectomy. Abdom Radiol 43, 2987–2990 (2018). https://doi.org/10.1007/s00261-018-1580-6

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  • DOI: https://doi.org/10.1007/s00261-018-1580-6

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