title: Clinical usefulness of intraductal ultrasonography for the management of acute biliary pancreatitis.
abstract: OBJECTIVE
  Identifying a bile duct (BD) stone in patients with acute biliary pancreatitis (ABP) is important for the management and prevention of recurrent attack of pancreatitis. However, small BD stones may not be detected on endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to prospectively evaluate the usefulness of intraductal ultrasonography (IDUS) in patients suspected to have ABP but with no evidence of choledocholithiasis on ERCP.
  
  
  METHODS
  A total 92 patients suspected with ABP without evidence of BD stones on imaging studies including ERCP were enrolled. Wire-guided IDUS was performed during ERCP in all patients. Stones or sludge detected by IDUS were confirmed after endoscopic sphincterotomy (EST) and extraction. If IDUS finding was negative, then we swept the BD with a balloon catheter and/or basket without EST. After endoscopic management, comparison between IDUS and endoscopic finding was carried out to determine the diagnostic accuracy of IDUS.
  
  
  RESULTS
  Among the 92 patients, IDUS revealed BD stones in 33 (35.9%). All 33 patients' stones were confirmed by endoscopic visualization after EST and BD exploration. During the mean follow up of 24 months, recurrent pancreatitis did not occur in 90 of 92 patients (97.9%) with ABP after endoscopic treatment according to the IDUS findings.
  
  
  CONCLUSIONS
  IDUS improves diagnostic accuracy for the detection of clinically occult BD stones in patients suspicious ABP. IDUS-guided endoscopic management for patients with ABP can avoid unnecessary EST and help prevent recurrent pancreatitis.
authors.affiliation: Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, Bucheon and Seoul, Korea.
authors.forename: La Young
authors.initials: LY
authors.lastname: Yoon
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Moon
authors.forename: Hyun Jong
authors.initials: HJ
authors.lastname: Choi
authors.forename: Dong Choon
authors.initials: DC
authors.lastname: Kim
authors.forename: Jung Yeon
authors.initials: JY
authors.lastname: Seo
authors.forename: Tae Hoon
authors.initials: TH
authors.lastname: Lee
authors.forename: Sang-Woo
authors.initials: SW
authors.lastname: Cha
authors.forename: Young Deok
authors.initials: YD
authors.lastname: Cho
authors.forename: Sang-Heum
authors.initials: SH
authors.lastname: Park
authors.forename: Sun-Joo
authors.initials: SJ
authors.lastname: Kim
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D042883:Choledocholithiasis / Q000150:complications* / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000517:prevention & control; D011446:Prospective Studies; D012008:Recurrence; D012680:Sensitivity and Specificity; D016717:Sphincterotomy, Endoscopic; D018084:Ultrasonography, Interventional
keywords: biliary pancreatitis; choledocholithiasis; endoscopic retrograde cholangiopancreatography; intraductal ultrasonography