[Intraductal ultrasonography for the selection of self expandable metal stent in extrahepatic bile duct carcinoma].
OBJECTIVE
Endoscopic stent insertion with self expandable metal stent (SEMS) is one of the standard palliative treatments for the patients with unresectable bile duct carcinoma. The aim of this study was to determine whether detection of longitudinal spread of extrahepatic bile duct carcinoma by intraductal US (IDUS) would be helpful in the selection of metal stent for the palliative drainage in bile duct carcinoma.


METHODS
Seventeen patients with histologically proven unresectable extrahepatic bile duct carcinoma who underwent endoscopic retrograde cholangiography with IDUS were included. Longitudinal cancer extension along the bile duct was determined and, then, compared with the cholangiographic image. The type and length of SEMS was selected based on IDUS findings.


RESULTS
IDUS demonstrated more extensive tumor spread than ERC in 7 of 17 (41.2%) patients with the hepatic side of strictures and in 7 of 16 (43.8%) patients with the duodenal side of strictures. Five of 17 (29.4%) patients have changed the plan of endoscopic biliary drainage with SEMS after IDUS. There was no early dysfunction associated with endoscopic biliary drainage.


CONCLUSIONS
IDUS prior to biliary drainage would be useful in demonstrating longitudinal extension of extrahepatic bile duct carcinoma. It has a potential role in helping stent selection and identifying factors which predict early stent dysfunction.
Yoon
Hyung Geun
HG
Digestive Disease Center, Institute for Digestive Research, Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Yongsan-Gu, Seoul, Korea.
Kang
Jee Heon
JH
Lee
Eun Jeung
EJ
Moon
Jong Ho
JH
Kim
Sang Gyun
SG
Gheon
Young Koog
YK
Kim
Young Seok
YS
Cho
Young Deok
YD
Lee
Joon Seong
JS
Lee
Moon Sung
MS
Park
Seong Jin
SJ
Lee
Hae Kyung
HK
Shim
Chan Sup
CS
Kim
Boo Sung
BS
D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D017734:Bile Ducts, Extrahepatic / Q000000981:diagnostic imaging* / Q000601:surgery*; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D015607:Stents; D014463:Ultrasonography