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Abdominal Radiology

, Volume 43, Issue 11, pp 2987–2990 | Cite as

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

  • Thomas Togliani
  • Stefano Pilati
  • Andrea Lisotti
  • Giancarlo Caletti
  • Pietro Fusaroli
Article

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.

Keywords

Billroth II gastrectomy Common bile duct obstruction Extrahepatic lithiasis Endoscopic ultrasonography Extraductal ultrasound 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Endoscopy Unit, Department of Surgical SciencesHospital of MantovaMantuaItaly
  2. 2.Gastroenterology Unit, Department of Medical and Surgical Sciences, University of BolognaHospital of ImolaImolaItaly

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