Assessment of residual bile duct stones with use of intraductal US during endoscopic balloon sphincteroplasty: comparison with balloon cholangiography.
BACKGROUND
We sought to determine the utility of intraductal ultrasonography (IDUS) in detecting residual bile duct stones during endoscopic balloon sphincteroplasty.


METHODS
Eighty-one consecutive patients with bile duct stones who underwent IDUS during endoscopic balloon sphincteroplasty were studied. IDUS was performed with a thin-caliber ultrasonic probe (diameter 2.0 mm, frequency 20 MHz) by a transpapillary route after stone extraction. When IDUS or balloon-retrograde cholangiography suggested residual stones, the bile duct was cleared again with a Dormia basket. Extraction of the stones was confirmed by direct duodenoscopic visualization. Videotapes of IDUS and cholangiograms were reviewed retrospectively without knowledge of the results of other diagnostic modalities.


RESULTS
In 27 of 81 patients (33%), IDUS detected small residual stones not seen on cholangiography. When stones were fragmented with mechanical lithotripsy, the accuracy of IDUS in detecting small residual stones was significantly greater than that of balloon-endoscopic retrograde cholangiography (95% vs 50%, p < 0. 001). When the bile duct was greater than 10 mm in diameter, the accuracy of IDUS in detecting small residual stones was significantly greater than that of cholangiography (92% vs. 56%, p < 0.001).


CONCLUSIONS
IDUS is useful for detecting small residual bile duct stones during endoscopic balloon sphincteroplasty when stones are fragmented by mechanical lithotripsy or when there is evidence of a dilated bile duct (>10 mm).
Ohashi
A
A
Department of Gastroenterology, Jichi Medical School, Tochigi, Japan.
Ueno
N
N
Tamada
K
K
Tomiyama
T
T
Wada
S
S
Miyata
T
T
Nishizono
T
T
Tano
S
S
Aizawa
T
T
Ido
K
K
Kimura
K
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000009:adverse effects / Q000379:methods*; D002758:Cholangiography / Q000009:adverse effects / Q000379:methods*; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008096:Lithotripsy; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D009803:Sphincter of Oddi; D018084:Ultrasonography, Interventional / Q000009:adverse effects / Q000379:methods*