Ultrasonographic evaluation of the common bile duct in biliary acute pancreatitis patients: comparison with endoscopic retrograde cholangiopancreatography.

Abstract

We compared the morphologic findings of the common bile duct by ultrasonography and endoscopic retrograde cholangiopancreatography in patients with biliary acute pancreatitis. Forty‐five patients were studied. The diagnosis of acute pancreatitis was based on the presence of characteristic abdominal pain associated with an elevation of serum amylase and lipase concentrations. All patients underwent ultrasonography and subsequently urgent endoscopic retrograde cholangiopancreatography and eventually endoscopic sphincterotomy. Ultrasonography showed gallstones in 33 patients and sludge of the gallbladder in seven patients. In the common bile duct, lithiasis was found in two patients and sludge in 25. Endoscopic retrograde cholangiopancreatography showed choledocolithiasis in eight patients and sludge of the common bile duct in 32. In 27 cases (60%) concordance occurred between ultrasonographic and endoscopic retrograde cholangiopancreatographic detection of lithiasis or sludge of the common bile duct. The average diameter of the common bile duct determined by sonography was significantly smaller (P < 0.001) than that obtained by endoscopic retrograde cholangiopancreatography. The evaluation of this parameter indicated that a good correlation existed between the values obtained with the two techniques (r(s) = 0.765, P < 0.001). Both ultrasonography and endoscopic retrograde cholangiopancreatography can provide reliable measurements of the common bile duct diameter. Ultrasonography is the technique of choice in the initial investigation of patients with biliary acute pancreatitis.

Markers for predicting severity and progression of acute pancreatitis

“…It complements the clinical diagnosis, and in particular gives hints on the aetiology of the disease, as stones in the gallbladder and the common bile duct can be detected with very high sensitivity (up to 100%) and specificity (up to 100%). 68,69 There is, however, a limitation regarding optimal visualisation of the pancreas in the early phase of acute pancreatitis due to meteorism and abdominal pain. If the organ can be adequately visualised, swelling of the pancreatic parenchyma or changes in the pancreatic structure can be observed.…”

Management of severe acute pancreatitis

“…However, ultrasonography is useful in determining the aetiology of pancreatitis, by demonstrating gallstones or common bile duct dilatation, and detecting free peritoneal fluid 30 . It is recommended as the initial investigation in all patients with acute pancreatitis 32 , especially if gallstones are suspected 33 .…”

Nichttraumatisches akutes Abdomen: Ultraschalldiagnostik der Erkrankungen des Gastro-Intestinaltraktes

“…Der Ultraschall kann also nur einen begrenzten Beitrag zur Einschätzung der Schwere einer Pankreatitis leisten [51]. Dagegen bleibt der Ultraschall vor der ERCP und der Computertomographie das Mittel der Wahl, um eine Obstruktion zu beweisen [52]. Beim Vorhandensein einer Pseudozyste ermöglicht die Echographie die ultraschallgestützte Drainage [53].…”