Wire-guided intraductal US in the assessment of bile duct strictures with Mirizzi syndrome-like features at ERCP.
BACKGROUND
Mirizzi syndrome refers to common hepatic duct obstruction caused by extrinsic compression that is usually from a stone impacted in the cystic duct. The utility of transpapillary intraductal US for assessment of biliary strictures with radiographic features of Mirizzi syndrome was studied retrospectively.


METHODS
Intraductal US was performed in 16 patients with a common hepatic duct stricture caused by extrinsic compression and nonvisualization of the gallbladder by endoscopic retrograde cholangiography. An over-the-wire catheter US probe (20 MHz) was inserted into the bile duct. Intraductal US findings were compared with the final diagnoses at surgery.


RESULTS
Intraductal US was successful in all patients. The extraluminal cause of the common hepatic duct stricture was detected in 14 patients (87.5%). In 9 patients, intraductal US detected an impacted stone outside the common hepatic duct. Intraductal US demonstrated extraluminal lesions without evidence of a stone in 5 patients, including a mass in 4 and asymmetrical, irregular thickening of the bile duct wall in 1 patient. In the remaining 2 patients, intraductal US demonstrated only a distended gallbladder.


CONCLUSIONS
Transpapillary wire-guided intraductal US is useful for assessing biliary strictures with features that suggest Mirizzi syndrome and optimizes management of patients with these findings.
Moon
Jong Ho
JH
Institute for Digestive Research, Digestive Disease Center, Soon Chun Hyang University College of Medicine, Seoul, Korea.
Cho
Young Deok
YD
Cheon
Young Koog
YK
Ryu
Chang Beom
CB
Kim
Young Seok
YS
Kim
Jin Oh
JO
Cho
Joo Young
JY
Kim
Yun Soo
YS
Lee
Joon Seong
JS
Lee
Moon Sung
MS
Shim
Chan Sup
CS
Kim
Boo Sung
BS
D000368:Aged; D017734:Bile Ducts, Extrahepatic / Q000000981:diagnostic imaging / Q000473:pathology*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002769:Cholelithiasis / Q000175:diagnosis / Q000000981:diagnostic imaging*; D001651:Cholestasis, Extrahepatic / Q000000981:diagnostic imaging* / Q000473:pathology; D003251:Constriction, Pathologic; D003549:Cystic Duct / Q000000981:diagnostic imaging / Q000473:pathology; D019160:Endosonography; D005260:Female; D006500:Hepatic Duct, Common / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis; D012189:Retrospective Studies; D013577:Syndrome