Clinical Endoscopy

Review

Intraductal ultrasonography for biliary strictures: Young Koog Cheon; Clin Endosc 2023;56(2):164-168. Published online February 17, 2023; DOI: https://doi.org/10.5946/ce.2022.184

When diagnosing the nature of biliary strictures, it is sometimes difficult to perform non-invasive methods such as ultrasound, spiral computed imaging, magnetic resonance imaging, or endoscopic ultrasonography. Thus, treatment decisions are usually based on biopsy results. However, brush cytology or biopsy, which is widely used for biliary stenosis, has limitations owing to its low sensitivity and negative predictive value for malignancy. Currently, the most accurate method is bile duct tissue biopsy under direct cholangioscopy. On the other hand, intraductal ultrasonography administered under the guidance of a guidewire has the advantages of easy administration and being less invasive, allowing for adequate examination of the biliary tract and surrounding organs. This review discusses the usefulness and drawbacks of intraductal ultrasonography for biliary strictures.

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Original Article

A New Technique of Endoscopic Transpapillary Gallbladder Drainage Combined with Intraductal Ultrasonography for the Treatment of Acute Cholecystitis: Ryota Sagami, Kenji Hayasaka, Tetsuro Ujihara, Ryotaro Nakahara, Daisuke Murakami, Tomoyuki Iwaki, Satoshi Suehiro, Yasushi Katsuyama, Hideaki Harada, Yuji Amano; Clin Endosc 2020;53(2):221-229. Published online November 5, 2019; DOI: https://doi.org/10.5946/ce.2019.099

Abstract PDF PubReader ePub

Background
/Aims: Endoscopic transpapillary gallbladder drainage (ETGBD) is useful for the treatment of acute cholecystitis; however, the technique is difficult to perform. When intraductal ultrasonography (IDUS) is combined with ETGBD, the orifice of the cystic duct in the common bile duct may be more easily detected in the cannulation procedure. The aim of this study was to evaluate the efficacy of ETGBD with IDUS compared with that of ETGBD alone.
Methods
A total of 100 consecutive patients with acute cholecystitis requiring ETGBD were retrospectively recruited. The first 50 consecutive patients were treated using ETGBD without IDUS, and the next 50 patients were treated using ETGBD with IDUS. Through propensity score matching analysis, we compared the clinical outcomes between the groups. The primary outcome was the technical success rate.
Results
The technical success rate of ETGBD with IDUS was significantly higher than that of ETGBD without IDUS (92.0% vs. 76.0%, p=0.044). There was no significant difference in procedure length between the two groups (74.0 min vs. 66.7 min, p=0.310). The complication rate of ETGBD with IDUS was significantly higher than that of ETGBD without IDUS (6.0% vs. 0%, p<0.001); however, only one case showed an IDUS technique-related complication (pancreatitis).
Conclusions
The assistance of IDUS may be useful in ETGBD.

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Yuki Kawasaki, Jun Ushio, Hisaki Kato, Kazuya Sumi, Yuki Shibata, Norihiro Nomura, Junichi Eguchi, Takayoshi Ito, Haruhiro Inoue
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Manuela Götzberger, Natascha Nüssler, Barbara Braden, Christoph F. Dietrich, Thomas Müller
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Teruaki Miyauchi, Kenji Shimura
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Clement Chun Ho Wu, Christopher Jen Lock Khor
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Case Report

Endoscopic Extraction of Biliary Fascioliasis Diagnosed Using Intraductal Ultrasonography in a Patient with Acute Cholangitis: Ji Su Ha, Hyun Jong Choi, Jong Ho Moon, Yun Nah Lee, Jae Woong Tae, Moon Han Choi, Tae Hoon Lee, Sang-Woo Cha; Clin Endosc 2015;48(6):579-582. Published online November 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.6.579

Abstract PDF PubReader ePub

Fasciola hepatica infection may result in biliary obstruction with or without cholangitis in the chronic biliary phase. Because clinical symptoms and signs of F. hepatica are similar to other biliary diseases that cause bile duct obstruction, such as stones or bile duct malignancies, that are, in fact, more common, this condition may not be suspected and diagnosis may be overlooked and delayed. Patients undergoing endoscopic retrograde cholangiopancreatography or endoscopic ultrasonography for the evaluation of bile duct obstruction may be incidentally detected with the worm, and diagnosis can be confirmed by extraction of the leaf-like trematode from the bile duct. Intraductal ultrasonography (IDUS) can provide high-resolution cross-sectional images of the bile duct, and is useful in evaluating indeterminate biliary diseases. We present a case of biliary fascioliasis that was diagnosed using IDUS and managed endoscopically in a patient with acute cholangitis.

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Original Article

Endosonographic Preoperative Evaluation for Tumors of the Ampulla of Vater Using Endoscopic Ultrasonography and Intraductal Ultrasonography: Naoki Okano, Yoshinori Igarashi, Seiichi Hara, Kensuke Takuma, Itaru Kamata, Yui Kishimoto, Takahiko Mimura, Ken Ito, Yasukiyo Sumino; Clin Endosc 2014;47(2):174-177. Published online March 31, 2014; DOI: https://doi.org/10.5946/ce.2014.47.2.174

Abstract PDF PubReader ePub

Background/Aims

In recent years, endoscopic snare papillectomy has been performed to treat tumors of the ampulla of Vater. This procedure requires accurate preoperative evaluation. In this study, we diagnosed the focal extension of such tumors by using endoscopic ultrasonography (EUS) and intraductal ultrasonography (IDUS), and examined the indications for endoscopic snare papillectomy.

Methods

The subjects were 48 patients with a papillary tumor (13 patients, surgical resection; 35 patients, endoscopic snare papillectomy) who were evaluated preoperatively with EUS and IDUS. The tumor-node-metastasis classification was used for the endosonographic evaluation and pathological diagnosis of these tumors.

Results

The diagnostic accuracy of EUS was 97% for diagnosing adenomas and pTis tumors, 73% for pT1 tumors, 50% for pT2 tumors, and 50% for pT3-4 tumors, for an overall accuracy of 85% for T-staging. The diagnostic accuracy of IDUS was 94% for adenomas and pTis tumors, 73% for pT1 tumors, 50% for pT2 tumors, and 100% for pT3-4 tumors, for an overall accuracy of 80% for T-staging.

Conclusions

EUS and IDUS are highly capable of evaluating tumors of the ampulla of Vater preoperatively. However, these techniques are not sufficient for evaluating the focal extension of carcinomas preoperatively. Currently, endoscopic snare papillectomy is adequate for treating adenomas and pTis tumors.

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Diagnostic accuracy of endoscopic ultrasound and intraductal ultrasonography for assessment of ampullary tumors: a meta-analysis
Xiaohua Ye, Lei Wang, Zhendong Jin
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The Long-Term Outcomes of Endoscopic Papillectomy and Management of Cases of Incomplete Resection: A Single-Center Study
Shinichiro Muro, Hironari Kato, Akihiro Matsumi, Yuki Ishihara, Yosuke Saragai, Shuntaro Yabe, Saimon Takata, Daisuke Uchida, Takeshi Tomoda, Kazuyuki Matsumoto, Shigeru Horiguchi, Hiroyuki Okada
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Hiroki Kawashima, Eizaburo Ohno, Takuya Ishikawa, Tadashi Iida, Hiroyuki Tanaka, Kazuhiro Furukawa, Masanao Nakamura, Takashi Honda, Senju Hashimoto, Akihiro Itoh, Masatoshi Ishigami, Yoshiki Hirooka, Mitsuhiro Fujishiro
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Special Issue Articles of IDEN 2012

Usefulness of Intraductal Ultrasonography in the Diagnosis of Cholangiocarcinoma and IgG4-Related Sclerosing Cholangitis: Takahiro Nakazawa, Itaru Naitoh, Kazuki Hayashi; Clin Endosc 2012;45(3):331-336. Published online August 22, 2012; DOI: https://doi.org/10.5946/ce.2012.45.3.331

Abstract PDF PubReader ePub

The technique of intraductal ultrasonography (IDUS) of the bile duct with a thin-caliber probe and a ropeway system has provided excellent images of the bile duct and periductal structures and is an easy transpapillary approach. In addition, once the guide wire is inserted into the bile duct, IDUS and transpapillary biopsy after endoscopic retrograde cholangiopancreatography can be performed in a single session. Here, we review the usefulness of IDUS in the diagnosis of cholangiocarcinoma and IgG4-related sclerosing cholangitis.

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Intraductal Papillary Mucinous Neoplasm of the Pancreas: The Role of Intraductal Ultrasonography in Selection of Resection Method of Pancreas: Seung Hoon Baek, M.D., Young Deok Cho, M.D., Jae Young Jang, M.D., Young Koog Cheon, M.D., Young Seok Kim, M.D., Jong Ho Moon, M.D., Yun Soo Kim, M.D., Moon Sung Lee, M.D., Kyung Yul Hur, M.D., Chan Sup Shim, M.D. and Boo Sung Kim, M.D.; Korean J Gastrointest Endosc 2005;31(2):90-96. Published online August 30, 2005

Abstract PDF: Background
/Aims: The treatment of choice of intraductal papillary mucinous neoplasm (IPMN) is partial pancreatic resection with complete excision of this potentially malignant lesion, thus preserving sufficient pancreatic tissue to ensure endocrine and exocrine functions. This strategy, however, requires a reliable preoperative assessment of the highly variable extension of IPMN. We performed this study to determine the role of intraductal ultrasonography (IDUS) in predicting the extension of IPMN and selecting the resection methods of pancreas. Methods: A preoperative assessment of IPMN by IDUS was performed in 12 patients who underwent a surgical resection of IPMN. According to the preoperative localization of IPMN by IDUS, various types of limited pancreatic resections were planned. The histologic examination of the frozen section of the pancreatic cut surface was performed in all patient. In the cases of tumor involvement as cut surface margin, a modification of the planned pancreatic resection was done. Results: Technical success was achieved in all 12 cases (100%). There were positive tumor margin of cut surfaces in 2 patients. Of 10 cases whose frozen tissue evaluation of the pancreatic cut surface had been negative at first, one patieat has turned out to be margin positive in permanent section examination, finally. Overall accuracy of IDUS in predicting the continuous extension of IPMN was 75%. Conclusions: IDUS is a reliable diagnostic modality to guide the resection extent of the pancreas in patients with IPMN. (Korean J Gastrointest Endosc 2005;31:90⁣96)

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내시경적 역행성 담관 조영술 및 관강내 세경초음파 검사술로 확진된 간흡충증: Korean J Gastrointest Endosc 2003;27(5):500-500. Published online November 20, 2003

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ERC 상의 작은 음영결손(＜5 mm)의 감별진단에 대한 관강내 세경초음파검사술(IDUS)의 유용성: Korean J Gastrointest Endosc 2003;27(5):412-412. Published online November 20, 2003

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N내시경적 유두부 풍선확장술 후 잔류결석의 진단 및 담관 내 공기음영과의 감별에 있어서 관강 내 세경초음파검사술의 역할 ( The Role of Intraductal Ultrasonography on the Detection of Small Remnant Stones and Their Differentiation from Air-Bubbles, after Endoscopic Papillary Balloon Dilatation ): Korean J Gastrointest Endosc 1999;19(3):386-393. Published online November 30, 1998

Abstract PDF: Background
/Aims: A cholangiogram, immediately taken after bile duct stone removal, does not always provide adequate information about the presence of fragmented small stones in the bile duct, due to a large amount of bowel gas around the commom bile duct (CBD) or air-bubbles in the bile duct. We performed this study to evaluate the clinical usefulness of intraductal ultrasonography (IDUS) on the detection of small remnant stones after endoscopic papillary balloon dilatation (EPBD). Methods: Among the 42 patients treated with EPBD for the removal of CBD stones, 19 patients who had undergone ESWL or mechanical lithotripsy with basket, were evaluated by IDUS for the detection of remnant bile duct stones. Results: 17 out of 19 (89.5%) patients were successfully performed IDUS. Among the 17 patients, 13 showed no definite stones on cholangiogram, but CBD stones were detected using IDUS in 4 patients (30.7%). Among the 4 whose cases were difficult to differentiate air-bubbles from stones on a cholangiogram, 3 patients were diagnosed as having air-bubbles and 1 patient was diagnosed as having stones, through IDUS. During the process of conducting IDUS 19 times, one ultrasonic miniature probe was damaged. Conclusions: IDUS is very effective in detecting remnant small bile duct stones that are occasionally undetected on cholangiogram, and in differentiating stones from air-bubbles just after the removal of stones using EPBD. More efforts, however, are needed to improve the durability of the ultrasonic miniature probe. (Korean J Gastrointest Endosc 19: 386∼393, 1999)

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