Korean Journal of Gastrointestinal Endoscopy 1999;19(3): 394-401.
내시경적 역행성 담췌관 조영술로 진단에 실패한 총담관결석에 대한 초음파내시경의 유용성 ( Diagnostic Utility of Endoscopic Ultrasonograpy (EUS) for Common Bile Duct (CBD) Stones not Confirmed by Endoscopic Retrograde Cholangiopancreatography (ERCP) )
강동구, 이은우, 김도현, 김윤아, 박혁, 강명원, 임연근, 여향순, 박홍배 (Dong Goo Kang, Eun Woo Lee, Do Hyun Kim, Youn Ah Kim, Hyuck Park, Myung Weon Kang, Yeun Keun Lim, Hyang Soon Yeo and Hong Bae Park)
Abstract
Background/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is the best imaging procedure for the diagnosis of common bile duct (CBD) stones. But the difficulties of diagnosis are mostly due to problems involving cannulation, microlithiasis and pancreatitis etc. The diagnostic utility of endoscopic ultrasonography (EUS) for the diagnosis of CBD stones not detected by ERCP was retrogradely assessed in 8 patients. Methods: All the patients (N=98) underwent ERCP, and in the case where CBD stones were not confirmed by ERCP, EUS was performed. Final diagnosis was determined by ERCP with an endoscopic sphincterotomy (EST) or operative exploration. Results: 98 patients with CBD stones were studied. The first ERCP successfully imaged CBD stones in 90 patients and an EST was performed in 84 patients. In 6 patients, stones were removed through operative exploration. ERCP images were incomplete or of poor quality in 8 patients. EUS images were excellent or good in all 8 cases, where ERCP was ineffective. Factors associated with incomplete results for CBD stones included; inability to cannulate the ampulla of Vater (N=1), nonvisualized CBD (N=4), microlithiasis (N=2), and association with the periampullary fistula (N=1). The second ERCP and EST successfully confirmed the diagnosis of CBD stones in 6 patients. In 2 patients, operative exploration was needed to confirm the diagnosis of CBD stones. Conclusions: An EUS appears to be an accurate and useful diagnostic tool for assessing CBD stones in cases where an ERCP was ineffective. (Korean J Gastrointest Endosc 19: 394∼401, 1999)
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