Assessment of residual bile duct stones with use of intraductal US during endoscopic balloon sphincteroplasty: comparison with balloon cholangiography

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

“…It achieves successful imaging in approximately 80-93 % of patients [14]. However, even with this study, small stones can be missed, especially in case of a dilated CBD [16]. Difficult differential diagnosis of small contrast defects between true stones and miscellaneous artifacts, such as those produced by air bubble, may interfere with diagnosis of choledocholithiasis [4,9,17].…”

Intraductal ultrasonography (IDUS) for the diagnosis of biliopancreatic diseases

“…The outer diameter of the probe currently in use ranges from 2.0 mm to 3.1 mm, which allows insertion through the working channel of an endoscope into a narrow lumen, such as the common channel in the papilla of Vater, the bile duct and the pancreatic duct. Use of high-frequency ultrasound (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) enables detailed visualisation of the structures within a radius of about two cm from the probe. However, it is not possible to visualise distant structures from the probe due to limited beam penetration.…”

“…IDUS is used for the assessment of the quality of duct clearance as well. Ohashi et al [14] addressed the usefulness of IDUS in the evaluation of the quality of duct clearance after EST or EPBD. Varadarajulu [15] reported improvement of differential diagnosis of bile duct stones from air bubbles by IDUS with the use of irrigation with 25 ml of saline during IDUS to obtain a better acoustic window.…”

“…As IDUS uses highfrequency ultrasound (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30), its image quality is very high within approximately 2-cm range of radius. The bile duct and the pancreatic duct, therefore, are good targets for the assessment by IDUS.…”

The role of endoscopic ultrasound in hepatobiliary disease

“…This modality is especially useful for those patients suspected of having microlithiasis or residual stones after attempted stone extraction [21,22]. ERCP has difficulty diagnosing small stones and differentiating stones from air bubbles within the duct.…”