Clinical utility of intraductal US for evaluation of choledocholithiasis

Intraductal US can improve the diagnostic accuracy of cholangiography performed under C-arm fluoroscopy in patients with suspected choledocholithiasis. This study aimed to determine the clinical utility of intraductal US for patient management.

Patients with suspected choledocholithiasis undergoing ERCP with a C-arm fluoroscope at two tertiary academic medical centers were enrolled. After initial cholangiography, findings and decisions concerning the need for further interventions were recorded. Intraductal US (20 MHz) was then selectively performed in patients with equivocal cholangiography or those without cholangiographic evidence of bile duct stones. Intraductal US was also performed after endoscopic sphincterotomy and stone extraction to confirm bile duct clearance.

Fifty-two patients (28 men, 24 women) were enrolled and intraductal US was selectively performed in 35 (64%). Of the 21 patients with normal cholangiography, 8 (38%) had stones or sludge by intraductal US. Endoscopic sphincterotomy was performed as a direct result of intraductal US in these 8 and the findings were confirmed in 7. In the 14 patients in whom cholangiography demonstrated small (<5 mm) or round filling defects, intraductal US concurred in 9 and found air bubble/no stone in 5. Sphincterotomy was avoided in these 5 patients. Overall, intraductal US led to a change in clinical management in 13 of 35 patients (37%) in whom it was performed.

Selective use of intraductal US affects the clinical management of a large proportion of patients who undergo C-arm fluoroscopy-guided ERCP for suspected bile duct stones.