Elsevier

Gastrointestinal Endoscopy

Volume 56, Issue 3, September 2002, Pages 372-379
Gastrointestinal Endoscopy

Original Articles
Evaluation of indeterminate bile duct strictures by intraductal US

Presented in part at the 65th annual meeting of the American College of Gastroenterology, October 13-18, 2000, New York (Am J Gastroenterol 2000;95:2487).
https://doi.org/10.1016/S0016-5107(02)70041-2Get rights and content

Abstract

Background: Cholangiography and tissue sampling (brush cytology, biopsy) are the standard nonsurgical techniques for determining whether a bile duct stricture is benign or malignant. The aim of this study was to determine whether intraductal US is of assistance in distinguishing benign from malignant biliary strictures. Methods: A retrospective review was undertaken of 30 patients with indeterminate bile duct strictures who underwent ERCP and tissue sampling from September 1999 to November 2000. A 20 MHz over-the-guidewire intraductal US catheter probe was used during ERCP for further examination of the strictures. Final diagnoses of malignant strictures (18 patients) were confirmed histopathologically; confirmation of benign stricture (12 patients) was based on negative tissue sampling plus extended clinical follow-up. Results: Based on retrospective blinded review, the diagnosis by ERCP was correct in 67% of patients, by tissue sampling in 68%, by combined ERCP/tissue sampling in 67%, and by intraductal US in 90% (p = 0.04 vs. ERCP/tissue sampling) of cases. No complication of intraductal US or ERCP was recorded. Conclusions: Intraductal US is safe and can improve on the ability at ERCP to distinguish benign from malignant biliary strictures. (Gastrointest Endosc 2002;56:372-9.)

Section snippets

Patients and methods

A retrospective chart review of all ERCP procedures performed between September 1999 and November 2000 identified 30 patients suspected to have a bile duct stricture of indeterminate nature based on US and CT (etiology unknown after both imaging studies with no definite mass identified by either) who underwent ERCP and IDUS. This comprised all patients who underwent both ERCP and IDUS during the study period. The study was approved by our institutional review board. All patients provided

Results

Thirty consecutive patients undergoing combined ERCP and IDUS were included. Patient demographics (age, gender, history of previous surgery) as well as the length, thickness, and location of the bile duct stricture are shown in Table 1.

. Patient characteristics

No. of patients30
Age (y), mean (SD)63 (17) (range 16-84)
Gender (M:F)21:9
Previous cholecystectomy7
Length of stricture (mm), mean (SD)17 (6) (range 12-20)
Thickness of stricture (mm), mean (SD)4 (2) (range 0.6-12)
Location of stricture
 CBD11
 

Discussion

The sensitivity, specificity, and accuracy of ERCP (respectively, 86%, 47%, and 73%), brush cytology (respectively, 54%, 100%, and 68%), and forceps biopsy (respectively, 53%, 100%, and 67%) in the evaluation of bile duct strictures are less than optimal.4, 5, 6 Whether IDUS improves these results has not been evaluated to date. The results of the present study suggest that IDUS provides additional information beyond that which can be obtained by ERCP, tissue sampling, or both. The overall

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    Reprint requests: Maurits J. Wiersema MD, 200 First St. SW, Mayo Clinic, Eisenberg 8A, Rochester, MN 55905.

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