Imaging: EUS and IDUS

  • Itaru NaitohEmail author
  • Takahiro Nakazawa
  • Hirotaka Ohara
  • Takashi Joh


EUS is an important procedure for the differential diagnosis of type 1 autoimmune pancreatitis (AIP) from other pancreatic diseases because IgG4-SC is often associated with type 1 AIP. Bile duct wall thickening is considered the EUS finding of IgG4-SC with type 1 AIP. Cholangiocarcinoma (CCA) and primary sclerosing cholangitis (PSC) are important diagnoses that should be differentiated from IgG4-SC. IDUS findings of non-stricture bile duct lesions are different between IgG4-SC and CCA. The thickening of the bile duct wall in non-stricture lesion is the most characteristic IDUS finding of IgG4-SC. The IDUS findings of stricture lesions are also different between IgG4-SC and PSC. IDUS is a useful modality for differentiating IgG4-SC from CCA and PSC, as the details of bile duct wall thickening are easily observable.


  1. 1.
    Tanaka A, Tazuma S, Okazaki K, Nakazawa T, Inui K, Chiba T, et al. Clinical features, response to treatment, and outcomes of IgG4-related sclerosing cholangitis. Clin Gastroenterol Hepatol. 2017;15(6):920–6 e3.CrossRefPubMedGoogle Scholar
  2. 2.
    Hoki N, Mizuno N, Sawaki A, Tajika M, Takayama R, Shimizu Y, et al. Diagnosis of autoimmune pancreatitis using endoscopic ultrasonography. J Gastroenterol. 2009;44(2):154–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Hyodo N, Hyodo T. Ultrasonographic evaluation in patients with autoimmune-related pancreatitis. J Gastroenterol. 2003;38(12):1155–61.CrossRefPubMedGoogle Scholar
  4. 4.
    Dietrich CF, Hirche TO, Ott M, Ignee A. Real-time tissue elastography in the diagnosis of autoimmune pancreatitis. Endoscopy. 2009;41(8):718–20.CrossRefPubMedGoogle Scholar
  5. 5.
    Hocke M, Ignee A, Dietrich CF. Contrast-enhanced endoscopic ultrasound in the diagnosis of autoimmune pancreatitis. Endoscopy. 2011;43(2):163–5.CrossRefPubMedGoogle Scholar
  6. 6.
    Imazu H, Kanazawa K, Mori N, Ikeda K, Kakutani H, Sumiyama K, et al. Novel quantitative perfusion analysis with contrast-enhanced harmonic EUS for differentiation of autoimmune pancreatitis from pancreatic carcinoma. Scand J Gastroenterol. 2012;47(7):853–60.CrossRefPubMedGoogle Scholar
  7. 7.
    Iwashita T, Yasuda I, Doi S, Ando N, Nakashima M, Adachi S, et al. Use of samples from endoscopic ultrasound-guided 19-gauge fine-needle aspiration in diagnosis of autoimmune pancreatitis. Clin Gastroenterol Hepatol. 2012;10(3):316–22.CrossRefPubMedGoogle Scholar
  8. 8.
    Kanno A, Ishida K, Hamada S, Fujishima F, Unno J, Kume K, et al. Diagnosis of autoimmune pancreatitis by EUS-FNA by using a 22-gauge needle based on the International Consensus Diagnostic Criteria. Gastrointest Endosc. 2012;76(3):594–602.CrossRefPubMedGoogle Scholar
  9. 9.
    Ohara H, Okazaki K, Tsubouchi H, Inui K, Kawa S, Kamisawa T, et al. Clinical diagnostic criteria of IgG4-related sclerosing cholangitis 2012. J Hepatobiliary Pancreat Sci. 2012;19(5):536–42.CrossRefPubMedGoogle Scholar
  10. 10.
    Tamada K, Tomiyama T, Oohashi A, Aizawa T, Nishizono T, Wada S, et al. Bile duct wall thickness measured by intraductal US in patients who have not undergone previous biliary drainage. Gastrointest Endosc. 1999;49(2):199–203.CrossRefPubMedGoogle Scholar
  11. 11.
    Naitoh I, Nakazawa T, Ohara H, Ando T, Hayashi K, Tanaka H, et al. Endoscopic transpapillary intraductal ultrasonography and biopsy in the diagnosis of IgG4-related sclerosing cholangitis. J Gastroenterol. 2009;44(11):1147–55.CrossRefPubMedGoogle Scholar
  12. 12.
    Kubota K, Kato S, Uchiyama T, Watanabe S, Nozaki Y, Fujita K, et al. Discrimination between sclerosing cholangitis-associated autoimmune pancreatitis and primary sclerosing cholangitis, cancer using intraductal ultrasonography. Dig Endosc. 2011;23(1):10–6.CrossRefPubMedGoogle Scholar
  13. 13.
    Moon SH, Kim MH. The role of endoscopy in the diagnosis of autoimmune pancreatitis. Gastrointest Endosc. 2012;76(3):645–56.CrossRefPubMedGoogle Scholar
  14. 14.
    Tabata T, Kamisawa T, Hara S, Kuruma S, Chiba K, Kuwata G, et al. Differentiating immunoglobulin g4-related sclerosing cholangitis from hilar cholangiocarcinoma. Gut Liver. 2013;7(2):234–8.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Kamisawa T, Ohara H, Kim MH, Kanno A, Okazaki K, Fujita N. Role of endoscopy in the diagnosis of autoimmune pancreatitis and immunoglobulin G4-related sclerosing cholangitis. Dig Endosc. 2014;26(5):627–35.CrossRefPubMedGoogle Scholar
  16. 16.
    Kanno A, Masamune A, Shimosegawa T. Endoscopic approaches for the diagnosis of autoimmune pancreatitis. Dig Endosc. 2015;27(2):250–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Hirano K, Tada M, Isayama H, Yamamoto K, Mizuno S, Yagioka H, et al. Endoscopic evaluation of factors contributing to intrapancreatic biliary stricture in autoimmune pancreatitis. Gastrointest Endosc. 2010;71(1):85–90.CrossRefPubMedGoogle Scholar
  18. 18.
    Naitoh I, Nakazawa T, Hayashi K, Miyabe K, Shimizu S, Kondo H, et al. Comparison of intraductal ultrasonography findings between primary sclerosing cholangitis and IgG4-related sclerosing cholangitis. J Gastroenterol Hepatol. 2015;30(6):1104–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Singapore 2019

Authors and Affiliations

  • Itaru Naitoh
    • 1
    Email author
  • Takahiro Nakazawa
    • 2
  • Hirotaka Ohara
    • 3
  • Takashi Joh
    • 1
  1. 1.Department of Gastroenterology and MetabolismNagoya City University Graduate School of Medical SciencesNagoyaJapan
  2. 2.Department of GastroenterologyNagoya Daini Red Cross HospitalNagoyaJapan
  3. 3.Department of Community-based Medical EducationNagoya City University Graduate School of Medical SciencesNagoyaJapan

Personalised recommendations