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The Role of EUS in the Biliary System

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Endoscopic Ultrasound

Part of the book series: Clinical Gastroenterology ((CG))

Abstract

Standard endoscopic ultrasound (EUS) and intraductal ultrasonography (IDUS) are, with magnetic resonance, the best techniques currently available to image the extrahepatic bile ducts and the gallbladder. In this chapter, we review current knowledge about gallstone disease, bile duct strictures, and gallbladder lesions.

In patients at high risk of having bile duct stones, endoscopic retrograde cholangio-pancreatography (ERCP) is the most cost-effective procedure, whereas EUS is indicated when the clinical index of suspicion for stones is low or intermediate (to spare costs and morbidity associated with ERCP). Sensitivity and specificity of EUS for the diagnosis of choledocholithiasis are close to 95%. In cases of unexplained acute pancreatitis, EUS provides a diagnosis in a majority of patients; in particular by detecting gallstone disease that had not been suspected at percutaneous ultrasonography.

For the diagnosis of malignant vs. benign biliary strictures, the accuracy of EUS without fine needle aspiration (FNA) is not as high (80%), but EUS-FNA (in particular of lymph nodes) alters patient management in a ­significant proportion of cases. IDUS is the best technique for assessing the longitudinal tumor extent as well as T (but not N) categories. IDUS may also assist in diagnosing malignant transformation in primary sclerosing cholangitis.

Gallbladder polypoid lesions are frequent and can better be assessed by EUS than by percutaneous ultrasonography. EUS may be useful to examine lesions measuring 5–10 mm in diameter.

Finally, the accuracy of EUS for staging gallbladder cancer is in the range of 80–90%; it is particularly useful to distinguish between T1 and T2 tumors because the therapeutic planning is markedly different between these two categories.

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  1. Service of Gastroenterology and Hepatology, Geneva University Hospitals, Micheli-du-Crest street, 241205, Geneva, Switzerland

    Jean-Louis Frossard MD & Jean-Marc Dumonceau MD

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  1. Jean-Louis Frossard MD
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  1. Digestive Health Center, University of Virginia Health System, Charlottesville, VA, USA

    Vanessa M. Shami MD (Associate Professor of Medicine Director of Endoscopic Ultrasound) (Associate Professor of Medicine Director of Endoscopic Ultrasound)

  2. Digestive Health Center, University of Virginia Helath System, Charlottesville, USA

    Michel Kahaleh MD (Associate Professor of Medicine Director of Pancreatico-Biliary Services) (Associate Professor of Medicine Director of Pancreatico-Biliary Services)

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Frossard, JL., Dumonceau, JM. (2010). The Role of EUS in the Biliary System. In: Shami, V.M., Kahaleh, M. (eds) Endoscopic Ultrasound. Clinical Gastroenterology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-480-7_14

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