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Digestive Diseases and Sciences

, Volume 59, Issue 8, pp 1902–1908 | Cite as

Usefulness of Intraductal Ultrasonography in Icteric Patients with Highly Suspected Choledocholithiasis Showing Normal Endoscopic Retrograde Cholangiopancreatography

  • Dong Choon Kim
  • Jong Ho Moon
  • Hyun Jong Choi
  • A Reum Chun
  • Yun Nah Lee
  • Min Hee Lee
  • Tae Hoon Lee
  • Sang Woo Cha
  • Sang Gyune Kim
  • Young Seok Kim
  • Young Deok Cho
  • Sang-Heum Park
  • Hae Kyung Lee
Original Article

Abstract

Background

Choledocholithiasis is one of the causes of jaundice and may require urgent treatment. Endoscopic retrograde cholangiopancreatography (ERCP) has been the primary management strategy for choledocholithiasis. However, small stones can be overlooked during ERCP.

Aim

The aim of this study was to evaluate the accuracy of intraductal ultrasonography (IDUS) for detecting choledocholithiasis in icteric patients with highly suspected common bile duct (CBD) stones without definite stone diagnosis on ERCP.

Methods

Ninety-five icteric (bilirubin ≥3 mg/dL) patients who underwent ERCP for highly suspected choledocholithiasis without definite filling defects on cholangiography were prospectively enrolled in the present study. We evaluated the bile duct using IDUS for the presence of stones or sludge. Reference standard for choledocholithiasis was endoscopic extraction of stone or sludge.

Result

Bile duct stones were detected with IDUS in 31 of 95 patients (32.6 %). IDUS findings were confirmed by endoscopic stone extraction in all patients. The mean diameter of CBD stones detected by IDUS was 2.9 mm (range 1–7 mm). IDUS revealed biliary sludge in 24 patients (25.2 %) which was confirmed by sludge extraction in 21 patients (87.5 %). In dilated CBD, detection rate of bile duct stone/sludge based on IDUS was significantly higher than in non-dilated CBD (p = 0.004).

Conclusion

IDUS is useful for the detection of occult CBD stone on ERCP in icteric patients with highly suspected CBD stones.

Keywords

Jaundice Choledocholithiasis Intraductal ultrasonography Endoscopic retrograde cholangiopancreatography 

Abbreviations

ERCP

Endoscopic retrograde cholangiopancreatography

IDUS

Intraductal ultrasonography

CBD

Common bile duct

EST

Endoscopic sphincterotomy

EUS

Endoscopic ultrasonography

CT

Computed tomography

MRCP

Magnetic resonance cholangiopancreatography

US

Ultrasonography

GB

Gallbladder

SD

Standard deviation

PPV

Positive predictive value

NPV

Negative predictive value

CI

Confidence interval

Notes

Acknowledgments

This work was supported by the SoonChunHyang University Research Fund. We thank A Ri Song, RN; Song Ah Jeong, RN; Sun Yeong Moon, RN; and the entire nursing staff for their support and assistance with the procedures.

Conflict of interest

None.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Dong Choon Kim
    • 1
  • Jong Ho Moon
    • 1
    • 3
  • Hyun Jong Choi
    • 1
  • A Reum Chun
    • 1
  • Yun Nah Lee
    • 1
  • Min Hee Lee
    • 2
  • Tae Hoon Lee
    • 1
  • Sang Woo Cha
    • 1
  • Sang Gyune Kim
    • 1
  • Young Seok Kim
    • 1
  • Young Deok Cho
    • 1
  • Sang-Heum Park
    • 1
  • Hae Kyung Lee
    • 2
  1. 1.Digestive Disease Center and Research Institute, Department of Internal MedicineSoonChunHyang University School of MedicineBucheon and SeoulKorea
  2. 2.Department of RadiologySoonChunHyang University School of MedicineBucheonKorea
  3. 3.Digestive Disease Center and Research InstituteSoonChunHyang University Bucheon HospitalBucheonKorea

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