Intraductal US

  • Claudio Giovanni De Angelis
  • Ludovica Venezia
  • Pablo Cortegoso Valdivia


Intraductal ultrasound (IDUS) provides real-time, cross-sectional imaging of pancreatobiliary ducts, walls, and surrounding structures during endoscopic retrograde cholangiopancreatography (ERCP). The high-frequency ultrasound (12–30 MHz) used offers a very high image quality within approximately 2-cm range of radius, useful for evaluation of biliopancreatic disease, both benign and malignant. The high sensitivity is applied in the evaluation of suspicious choledocholithiasis and neoplasms, in the distinction between benign and malignant bile duct strictures, and to assess tumor extension and invasion depth. IDUS is a quick procedure, safe, and well tolerated by the patients, without major complication or adverse events.


Intraductal ultrasound Miniprobes Pancreatobiliary malignancy stadiation Choledocolithiasis 


  1. 1.
    Varadarajulu S. A modified technique to overcome the limitations of intraductal ultrasound for diagnosis of common bile duct stones. Endoscopy. 2008;40(Suppl 2):E152.PubMedCrossRefGoogle Scholar
  2. 2.
    Bruno M, De Angelis C. IDUS and EDUS. In: De Angelis C, Bocus P, editors. IEC atlas of endoscopic ultrasound. Turin: Ed. Minerva Medica; 2013. p. 141–5.Google Scholar
  3. 3.
    Krishna NB, Saripalli S, Safdar R, Agarwal B. Intraductal US in evaluation of biliary strictures without a mass lesion on CT scan or magnetic resonance imaging: significance of focal wall thickening and extrinsic compression at the stricture site. Gastrointest Endosc. 2007;66(1):90–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Sun B, Hu B. The role of intraductal ultrasonography in pancreatobiliary diseases. Endosc Ultrasound. 2016;5(5):291–9.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Ang TL, Teo EK, Fock KM, Lyn Tan JY. Are there roles for intraductal US and saline solution irrigation in ensuring complete clearance of common bile duct stones? Gastrointest Endosc. 2009;69(7):1276–81.PubMedCrossRefGoogle Scholar
  6. 6.
    Tsuchiya S, Tsuyuguchi T, Sakai Y, Sugiyama H, Miyagawa K, Fukuda Y, et al. Clinical utility of intraductal US to decrease early recurrence rate of common bile duct stones after endoscopic papillotomy. J Gastroenterol Hepatol. 2008;23(10):1590–5.PubMedCrossRefGoogle Scholar
  7. 7.
    Tringali A, Lemmers A, Meves V, Terheggen G, Pohl J, Manfredi G, et al. Intraductal biliopancreatic imaging: European Society of Gastrointestinal Endoscopy (ESGE) technology review. Endoscopy. 2015;47(8):739–53.PubMedCrossRefGoogle Scholar
  8. 8.
    Venezia L, Cortegoso Valdivia P, Rizza S, Bruno M, De Angelis C. Intraductal ultrasound for second-level evaluation of biliary and ampullary stenoses: experience from the Turin Center. Endoscopy. 2018;50(04):S43. Scholar
  9. 9.
    Fujita N, Noda Y, Kobayashi G, Ito K, Horaguchi J, Koshita S, et al. Intraductal ultrasonography (IDUS) for the diagnosis of biliopancreatic diseases. Best Pract Res Clin Gastroenterol. 2009;23(5):729–42.PubMedCrossRefGoogle Scholar
  10. 10.
    Chen L, Lu Y, Wu J-C, Bie L, Xia L, Gong B. Diagnostic utility of endoscopic retrograde cholangiography/intraductal ultrasound (ERC/IDUS) in distinguishing malignant from benign bile duct obstruction. Dig Dis Sci. 2016;61(2):610–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Moon JH, Choi HJ, Kim HK, Kwon KW, Cheon YK, Cho YD, et al. The usefulness of IDUS-guided transpapillary bile duct biopsy for the diagnosis of malignant biliary strictures. Gastrointest Endosc. 2008;67(5):AB208.Google Scholar
  12. 12.
    Lim S-U, Park C-H, Kee W-J, Lee J-H, Rew S-J, Park S-Y, et al. Intraductal ultrasonography without radiocontrast cholangiogram in patients with extrahepatic biliary disease. Gut Liver. 2015;9(4):540–6.PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Tamada K, Ido K, Ueno N, Kimura K, Ichiyama M, Tomiyama T. Preoperative staging of extrahepatic bile duct cancer with intraductal ultrasonography. Am J Gastroenterol. 1995;90(2):239–46.PubMedGoogle Scholar
  14. 14.
    Meister T, Heinzow HS, Woestmeyer C, Lenz P, Menzel J, Kucharzik T, et al. Intraductal ultrasound substantiates diagnostics of bile duct strictures of uncertain etiology. World J Gastroenterol. 2013;19(6):874–81.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Tamada K, Nagai H, Yasuda Y, Tomiyama T, Ohashi A, Wada S, et al. Transpapillary intraductal US prior to biliary drainage in the assessment of longitudinal spread of extrahepatic bile duct carcinoma. Gastrointest Endosc. 2001;53(3):300–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Kim H-N, Park C-H, Cho E-A, Rew S-J, Park I-H, Lim S-U, et al. Role of balloon-sheathed intraductal ultrasonography for patients with extensive pneumobilia. Gut Liver. 2015;9(4):561–5.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Obana T, Fujita N, Noda Y, Kobayashi G, Ito K, Sugawara T, et al. Endoscopic biliary imaging and clinicopathological features of cystic duct cancer. J Gastroenterol. 2008;43(2):171–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Matsubara S, Arizumi T, Togawa O, Sasaki T, Yamamoto N, Nakai Y, et al. Endoscopic transpapillary approach to the gallbladder for diagnosing gallbladder cancer. Can J Gastroenterol. 2007;21(12):809–13.PubMedGoogle Scholar
  19. 19.
    Wehrmann T, Riphaus A, Martchenko K, Kokabpick S, Pauka H, Stergiou N, et al. Intraductal ultrasonography in the diagnosis of Mirizzi syndrome. Endoscopy. 2006;38(7):717–22.PubMedCrossRefGoogle Scholar
  20. 20.
    Cheon YK, Cho YD, Jeon SR, Moon JH, Jeong SW, Hur KY, et al. Pancreatic resection guided by preoperative intraductal ultrasonography for intraductal papillary mucinous neoplasm. Am J Gastroenterol. 2010;105(9):1963–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Hara T, Yamaguchi T, Ishihara T, Tsuyuguchi T, Kondo F, Kato K, et al. Diagnosis and patient management of intraductal papillary-mucinous tumor of the pancreas by using peroral pancreatoscopy and intraductal ultrasonography. Gastroenterology. 2002;122(1):34–43.PubMedCrossRefGoogle Scholar
  22. 22.
    Cellier C, Cuillerier E, Palazzo L, Rickaert F, Flejou JF, Napoleon B, et al. Intraductal papillary and mucinous tumors of the pancreas: accuracy of preoperative computed tomography, endoscopic retrograde pancreatography and endoscopic ultrasonography, and long-term outcome in a large surgical series. Gastrointest Endosc. 1998;47(1):42–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Kobayashi G, Fujita N, Noda Y, Ito K, Horaguchi J, Obana T, et al. Lateral spread along the main pancreatic duct in branch-duct intraductal papillary-mucinous neoplasms of the pancreas: usefulness of intraductal ultrasonography for its evaluation. Dig Endosc. 2011;23(1):62–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Elta GH, Enestvedt BK, Sauer BG, Marie Lennon A. ACG clinical guideline: diagnosis and management of pancreatic cysts. Am J Gastroenterol. 2018;113(4):464–79.PubMedCrossRefGoogle Scholar
  25. 25.
    Menzel J, Domschke W. Intraductal ultrasonography may localize islet cell tumours negative on endoscopic ultrasound. Scand J Gastroenterol. 1998;33(1):109–12.PubMedCrossRefGoogle Scholar
  26. 26.
    Kamisawa T, Zen Y, Nakazawa T, Okazaki K. Advances in IgG4-related pancreatobiliary diseases. Lancet Gastroenterol Hepatol. 2018;3(8):575–85.PubMedCrossRefGoogle Scholar
  27. 27.
    Nakazawa T, Naitoh I, Hayashi K. Usefulness of intraductal ultrasonography in the diagnosis of cholangiocarcinoma and IgG4-related sclerosing cholangitis. Clin Endosc. 2012;45(3):331.PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    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.PubMedCrossRefGoogle Scholar
  29. 29.
    Lee J-M, Park C-H, Rew S-J, Kim H-N, Lee H-J, Park I-H, et al. Intraductal ultrasonography-directed endoscopic retrograde biliary drainage without fluoroscopy. Endoscopy. 2014;46(Suppl 1 UCTN):E495.PubMedGoogle Scholar
  30. 30.
    Park S-Y, Park C-H, Lim S-U, Cho E-A, Lee D-H, Jun C-H, et al. Intraductal US-directed management of bile duct stones without radiocontrast cholangiography. Gastrointest Endosc. 2015;82(5):939–43.PubMedCrossRefGoogle Scholar
  31. 31.
    Takagi T, Irisawa A, Shibukawa G, Hikichi T, Obara K, Ohira H. Intraductal ultrasonographic anatomy of biliary varices in patients with portal hypertension. Endosc Ultrasound. 2015;4(1):44–51.PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    Ramchandani M, Nageshwar Reddy D, Lakhtakia S, Gupta R, Tandan M, Rao GV. Role of single-operator per-oral cholangioscopy and intraductal US in assessment of portal biliopathy (with videos). Gastrointest Endosc. 2014;79(6):1015–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Claudio Giovanni De Angelis
    • 1
  • Ludovica Venezia
    • 1
  • Pablo Cortegoso Valdivia
    • 1
  1. 1.Gastroenterology UnitAOU Città della Salute e della Scienza, Molinette HospitalTurinItaly

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