title: Usefulness of intraductal ultrasonography in icteric patients with highly suspected choledocholithiasis showing normal endoscopic retrograde cholangiopancreatography.
abstract: BACKGROUND
  Choledocholithiasis is one of the causes of jaundice and may require urgent treatment. Endoscopic retrograde cholangiopancreatography (ERCP) has been the primary management strategy for choledocholithiasis. However, small stones can be overlooked during ERCP.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the accuracy of intraductal ultrasonography (IDUS) for detecting choledocholithiasis in icteric patients with highly suspected common bile duct (CBD) stones without definite stone diagnosis on ERCP.
  
  
  METHODS
  Ninety-five icteric (bilirubin ≥ 3 mg/dL) patients who underwent ERCP for highly suspected choledocholithiasis without definite filling defects on cholangiography were prospectively enrolled in the present study. We evaluated the bile duct using IDUS for the presence of stones or sludge. Reference standard for choledocholithiasis was endoscopic extraction of stone or sludge.
  
  
  RESULTS
  Bile duct stones were detected with IDUS in 31 of 95 patients (32.6%). IDUS findings were confirmed by endoscopic stone extraction in all patients. The mean diameter of CBD stones detected by IDUS was 2.9 mm (range 1-7 mm). IDUS revealed biliary sludge in 24 patients (25.2%) which was confirmed by sludge extraction in 21 patients (87.5%). In dilated CBD, detection rate of bile duct stone/sludge based on IDUS was significantly higher than in non-dilated CBD (p = 0.004).
  
  
  CONCLUSIONS
  IDUS is useful for the detection of occult CBD stone on ERCP in icteric patients with highly suspected CBD stones.
authors.affiliation: Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon and Seoul, Korea.
authors.forename: Dong Choon
authors.initials: DC
authors.lastname: Kim
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Moon
authors.forename: Hyun Jong
authors.initials: HJ
authors.lastname: Choi
authors.forename: A Reum
authors.initials: AR
authors.lastname: Chun
authors.forename: Yun Nah
authors.initials: YN
authors.lastname: Lee
authors.forename: Min Hee
authors.initials: MH
authors.lastname: Lee
authors.forename: Tae Hoon
authors.initials: TH
authors.lastname: Lee
authors.forename: Sang Woo
authors.initials: SW
authors.lastname: Cha
authors.forename: Sang Gyune
authors.initials: SG
authors.lastname: Kim
authors.forename: Young Seok
authors.initials: YS
authors.lastname: Kim
authors.forename: Young Deok
authors.initials: YD
authors.lastname: Cho
authors.forename: Sang-Heum
authors.initials: SH
authors.lastname: Park
authors.forename: Hae Kyung
authors.initials: HK
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D042883:Choledocholithiasis / Q000000981:diagnostic imaging*; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult