title: Diagnosis of common bile duct calculi with intraductal ultrasonography during endoscopic biliary cannulation.
abstract: BACKGROUND
  Choledocholithiasis can be difficult to diagnose, even with direct cholangiography. We examined the role of biliary intraductal ultrasonography in detecting common bile duct stones that had been overlooked during endoscopic retrograde cholangiopancreatography.
  
  
  METHODS
  Eighty consecutive patients who underwent endoscopic retrograde cholangiography for suspected choledocholithiasis with negative results were evaluated with intraductal ultrasonography (20 MHz) for the presence of biliary concrements. The diagnostic criterion for stones was a strong-echo structure with acoustic shadowing. Materials of low amplitude echoes without acoustic shadowing were considered sludge.
  
  
  RESULTS
  Intrabile duct scanning was successful in all patients. Of the 80 patients, 20 (25%) had ultrasonic evidence of common bile duct stones. The stones measured 5 mm or less on ultrasound and their presence was confirmed macroscopically during endoscopic (17 patients) or laparoscopic (three patients) bile duct clearance. Another 37 patients (46%) had biliary sludge alone and have been followed up uneventfully.
  
  
  CONCLUSIONS
  Biliary intraductal ultrasonography may become a useful adjunct to establish the diagnosis of occult bile duct concrements and a guide to appropriate therapeutic selection during endoscopic biliary cannulation.
authors.affiliation: The 3rd Department of Internal Medicine, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8506, Japan. kubotay@takii.kmu.ac.jp
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Kubota
authors.forename: Makoto
authors.initials: M
authors.lastname: Takaoka
authors.forename: Shin
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Shibatani
authors.forename: Masaaki
authors.initials: M
authors.lastname: Shimatani
authors.forename: Shoichiroh
authors.initials: S
authors.lastname: Takamido
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Imai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D019160:Endosonography; D005260:Female; D042882:Gallstones / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged