Evaluation of indeterminate bile duct strictures by intraductal US.
BACKGROUND
Cholangiography and tissue sampling (brush cytology, biopsy) are the standard nonsurgical techniques for determining whether a bile duct stricture is benign or malignant. The aim of this study was to determine whether intraductal US is of assistance in distinguishing benign from malignant biliary strictures.


METHODS
A retrospective review was undertaken of 30 patients with indeterminate bile duct strictures who underwent ERCP and tissue sampling from September 1999 to November 2000. A 20 MHz over-the-guidewire intraductal US catheter probe was used during ERCP for further examination of the strictures. Final diagnoses of malignant strictures (18 patients) were confirmed histopathologically; confirmation of benign stricture (12 patients) was based on negative tissue sampling plus extended clinical follow-up.


RESULTS
Based on retrospective blinded review, the diagnosis by ERCP was correct in 67% of patients, by tissue sampling in 68%, by combined ERCP/tissue sampling in 67%, and by intraductal US in 90% (p = 0.04 vs. ERCP/tissue sampling) of cases. No complication of intraductal US or ERCP was recorded.


CONCLUSIONS
Intraductal US is safe and can improve on the ability at ERCP to distinguish benign from malignant biliary strictures.
Developmental Endoscopy Unit Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Enrique
E
Vazquez-Sequeiros
Todd H
TH
Baron
Jonathan E
JE
Clain
Christopher J
CJ
Gostout
Ian D
ID
Norton
Bret T
BT
Petersen
Michael J
MJ
Levy
Mary L
ML
Jondal
Maurits J
MJ
Wiersema
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015331:Cohort Studies; D003937:Diagnosis, Differential; D019160:Endosonography / Q000295:instrumentation*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity