Skip to main content

Advertisement

SpringerLink
Log in

Diagnostic Utility of Endoscopic Retrograde Cholangiography/Intraductal Ultrasound (ERC/IDUS) in Distinguishing Malignant from Benign Bile Duct Obstruction

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background and Aim

Accurately differentiating malignant diseases from benign ones in patients having bile duct obstruction is of significant importance and remains a major clinical problem. This study investigated the diagnostic yield of endoscopic retrograde cholangiography/intraductal ultrasound (ERC/IDUS) in distinguishing malignant from benign bile duct obstruction and assessed some image findings from ERC/IDUS which might be useful in differentiation.

Methods

From January 2008 to January 2015, patients who underwent ERC/IDUS for bile duct obstruction were enrolled. Patient’s ERC/IDUS diagnosis was compared with the final diagnosis determined by pathologic findings and/or clinical outcome of follow-up.

Results

One hundred and ninety-three patients with bile duct obstruction were included. IDUS correctly identified 94 of 97 malignant diseases and 76 of 96 benign diseases with sensitivity, specificity, and accuracy rate of 96.91, 79.17, and 88.08 %, respectively. Additionally, the accuracy rate of IDUS for diagnosis of proximal bile duct obstruction was higher than that of distal bile duct obstruction (98.08 vs. 82.73 %, p = 0.006). Besides, there was a significant difference in the length at the obstruction site between benign and malignant diseases (13.76 ± 7.37 vs. 19.97 ± 11.37 mm, p < 0.001) as well as thickness of bile duct wall at the site of obstruction (3.06 ± 0.92 vs. 7.03 ± 3.70 mm, p = 0.008). Biliary wall thickness >7 mm without extrinsic compression had a positive predictive value (PPV) of 100 % for including malignancy, while length ≧20 mm demonstrated a PPV of 93.44 %.

Conclusions

ERC/IDUS is effective in distinguishing malignant from benign bile duct obstruction, thus helping in further clinical management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Fogel EL, Sherman S. How to improve the accuracy of diagnosis of malignant biliary strictures. Endoscopy. 1999;31:758–760.

    Article  CAS  PubMed  Google Scholar 

  2. Devereaux CE, Binmoeller KF. Endoscopic retrograde cholangiopancreatography in the next millennium. Gastrointest Endosc Clin N Am. 2000;10:117–133.

    CAS  PubMed  Google Scholar 

  3. Fogel EL, deBellis M, McHenry L, et al. Effectiveness of a new long cytology brush in the evaluation of malignant biliary obstruction: a prospective study. Gastrointest Endosc. 2006;63:71–77.

    Article  PubMed  Google Scholar 

  4. Meister T, Heinzow HS, Woestmeyer C, et al. Intraductal ultrasound substantiates diagnostic of bile duct strictures of uncertain etiology. World J Gastroenterol. 2013;19:874–881.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Farrell RJ, Agarwal B, Brandwein SL, Underhill J, Chuttani R, Pleskow DK. Intraductal US is a useful adjunct to ERCP for distinguishing malignant from benign biliary strictures. Gastrointest Endosc. 2002;56:681–687.

    Article  PubMed  Google Scholar 

  6. Levy MJ, Baron TH, Clayton AC, et al. Prospective evaluation of advanced molecular markers and imaging techniques in patients with indeterminate bile duct strictures. Am J Gastroenterol. 2008;103:1263–1273.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Vazquez-Sequeiros E, Baron TH, Clain JE, et al. Evaluation of indeterminate bile duct strictures by intraductal US. Gastrointest Endosc. 2002;56:372–379.

    Article  PubMed  Google Scholar 

  8. Tamada K, Ueno N, Tomiyama T, et al. Characterization of biliary strictures using intraductal ultrasonography: comparison with percutaneous cholangioscopic biopsy. Gastrointest Endosc. 1998;47:341–349.

    Article  CAS  PubMed  Google Scholar 

  9. Meister T, Uphoff M-A, Heinecke A, Domagk D, Kunsch S, Lindhorst A. Novel score for prediction of malignant bile duct obstruction based on biochemical and clinical markers. Aliment Pharmacol Ther. 2015;41:877–887.

    Article  CAS  PubMed  Google Scholar 

  10. Choudari CP, Fogel E, Gottlieb SS, Lehman GA. Therapeutic biliary endoscopy. Endoscopy. 1998;30:163–173.

    Article  CAS  PubMed  Google Scholar 

  11. Stewart CJR, Mills PR, Carter R, et al. Brush cytology in the assessment of pancreatico-biliary strictures: a review of 406 cases. J Clin Pathol. 2001;54:449–455.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  12. Schoefl R, Haefner M, Wrba F, et al. Forceps biopsy and brush cytology during endoscopic retrograde cholangiopancreatography for the diagnosis of biliary stenoses. Scand J Gastroenterol. 1997;32:363–368.

    Article  CAS  PubMed  Google Scholar 

  13. Sugiyama M, Atomi Y, Wada N, Kuroda A, Muto T. Endoscopic transpapillary bile duct biopsy without sphincterotomy for diagnosing biliary strictures: a prospective comparative study with bile and brush cytology. Am J Gastroenterol. 1996;91:465–467.

    CAS  PubMed  Google Scholar 

  14. Kobayashi N, Sato T, Kato S, et al. Endoscopic treatment of postoperative benign bile duct stricture compared with malignant bile duct stricture. Hepatogastroenterology. 2014;61:1507–1518.

    PubMed  Google Scholar 

  15. Yock P, Johnson E, Lonker D. Intravascular ultrasound: development and clinical potential. Am J Card Imaging. 1988;2:185–193.

    Google Scholar 

  16. Meyer CR, Chiang EH, Fechner KP, Fitting DW, Williams DM, Buda AJ. Feasibility of high-resolution intravascular ultrasonic imaging catheters. Radiology. 1988;168:113–116.

    Article  CAS  PubMed  Google Scholar 

  17. Silverstein FE, Martin RW, Kimmey MB, Jiranek GC, Franklin DW, Proctor A. Experimental evaluation of an endoscopic ultrasound probe; in vitro and in vivo canine studies. Gastroenterology. 1989;96:1058–1062.

    CAS  PubMed  Google Scholar 

  18. Fujita N, Noda Y, Kobayashi G, et al. Intraductal ultrasonography (IDUS) for the diagnosis of biliopancreatic diseases. Best Pract Res Clin Gastroenterol. 2009;23:729–742.

    Article  PubMed  Google Scholar 

  19. Domagk D, Poremba C, Dietl KH, et al. Endoscopic transpapillary biopsies and intraductal ultrasonography in the diagnostics of bile duct strictures: a prospective study. Gut. 2002;51:240–244.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Menzel J, Poremba C, Dietl KH, Domschke W. Preoperative diagnosis of bile duct strictures–comparison of intraductal ultrasonography with conventional endosonography. Scand J Gastroenterol. 2000;35:77–82.

    Article  CAS  PubMed  Google Scholar 

  21. Tamada K, Ido K, Ueno N, Kimura K, Ichiyama M, Tomiyama T. Preoperative staging of extrahepatic bile duct cancer with intraductal ultrasonography. Am J Gastroenterol. 1995;90:239–246.

    CAS  PubMed  Google Scholar 

  22. Rösch T, Meining A, Frühmorgen S, et al. A prospective comparison of the diagnostic accuracy of ERCP, MRCP, CT, and EUS in biliary strictures. Gastrointest Endosc. 2002;55:870–876.

    Article  PubMed  Google Scholar 

  23. Levy MJ, Heimbach JK, Gores GJ. Endoscopic ultrasound staging of cholangiocarcinoma. Curr Opin Gastroenterol. 2012;28:244–252.

    Article  PubMed  Google Scholar 

  24. Mohamadnejad M, DeWitt JM, Sherman S, et al. Role of eus for preoperative evaluation of cholangiocarcinoma: a large single-center experience. Gastrointest Endosc. 2011;73:71–78.

    Article  PubMed  Google Scholar 

  25. Heinzow HS, Kammerer S, Rammes C, Wessling J, Domagk D, Meister T. Comparative analysis of ERCP, IDUS, EUS and CT in predicting malignant bile duct strictures. World J Gastroenterol. 2014;20(30):10495–10503.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Krishna NB, Saripalli S, Safdar R, Agarwal B. Intraductal US in evaluation of biliary strictures without a mass lesion on CT scan or magnetic resonance imaging: significance of focal wall thickening and extrinsic compression at the stricture site. Gastrointest Endosc. 2007;66:90–96.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank all the staffs from the Digestive Endoscopy Centre, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, for their help in this study.

Author information

Author notes

    Authors and Affiliations

    1. Digestive Endoscopy Center, Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China

      Lu Chen, Yi Lu, Jia-chuan Wu, Like Bie & Biao Gong

    2. Digestive Endoscopy Center, Shanghai International Medical Center, 4358 Kangxin Road, Shanghai, 201318, China

      Lu Xia

    Authors
    1. Lu Chen
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Yi Lu
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Jia-chuan Wu
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Like Bie
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Lu Xia
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Biao Gong
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Biao Gong.

    Ethics declarations

    Conflict of interest

    None.

    Additional information

    Lu Chen and Yi Lu have contributed equally to this manuscript.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Chen, L., Lu, Y., Wu, Jc. et al. Diagnostic Utility of Endoscopic Retrograde Cholangiography/Intraductal Ultrasound (ERC/IDUS) in Distinguishing Malignant from Benign Bile Duct Obstruction. Dig Dis Sci 61, 610–617 (2016). https://doi.org/10.1007/s10620-015-3896-1

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s10620-015-3896-1

    Keywords

    Search

    Navigation