Value and safety of ERCP and endoscopic treatment for acute biliary pancreatitis

Applicative value of intraductal ultrasonography in the removal of calculus by endoscopic retrograde cholangiopancreatgraphy

AIM: To discuss the value of intraductal ultrasonography (IDUS) in removing calculus by endoscopic retrograde cholangiopan-creatography (ERCP).

METHODS: One hundred patients with suspected extrahepatic bile duct stones were included in this study. ERCP was performed first followed by IDUS through endoscopic working channel to detect extrahepatic bile duct; finally the substance in extrahepatic bile duct was proved by endoscopic sphincterotomy (EST) and stone extraction. For the patients whose calculus was removed by galet basket, IDUS was performed again.

RESULTS: Of the 100 patients, bile duct stones were found in 93 cases, and cancer embolus, floccule, gas and Mirrizzi syndrome were found in 1 case respectively. Three cases were found without stones. Stones of 37 cases were extracted by galet basket and retained stones were found in 3 cases after ERCP. By ERCP, ninety-two cases were diagnosed with bile duct stones, 3 cases suspected, and 5 cases without stones and the final result showed that 3 cases were misdiagnosed. So the accuracy and sensitivity of ERCP were 97% and 94.8% respectively. By IDUS, no misdiagnosis and missing diagnosis occurred. So the accuracy and sensitivity of IDUS in the diagnosis of extrahepatic bile duct stones were 100% and 100% respectively.

CONCLUSION: IDUS can compensate the visual error of ERCP on extrahepatic bile duct stones. IDUS is superior to ERCP in the diagnosis of extrahepatic bile duct stones, especially cholangiectasis and Mirrizzi syndrome. Besides, IDUS can prevent retained stones after ERCP.