Therapeutic Efficacy and Safety Profile of Endoscopic Ultrasound (EUS) Guided Opacification, Cannulation and Therapy of the Common Bile Duct (CBD) and Wirsung (PD)

BACKGROUND: Endoscopic retrograde cholangiography is highly accurate in diagnosing choledocholithiasis, but it is the most invasive of the available methods. Endoscopic ultrasonography is a very accurate test for the diagnosis of choledocholithiasis with a risk of complications similar to that of upper gastrointestinal endoscopy. AIM: To compare the accuracy of endoscopic ultrassonography and endoscopic retrograde cholangiography in the diagnosis of common bile duct stones before laparoscopic cholecystectomy and to analyze endoscopic ultrasound results according to stone size and common bile duct diameter. PATIENTS AND METHODS: Two hundred and fifteen patients with symptomatic gallstones were admitted for laparoscopic cholecystectomy. Sixty-eight of them (31.7%) had a dilated common bile duct and/or hepatic biochemical parameter abnormalities. They were submitted to endoscopic ultrassonography and endoscopic retrograde cholangiography. Sphincterotomy and sweeping of the common bile duct were performed if endoscopic ultrassonography or endoscopic retrograde cholangiography were considered positive for choledocholithiasis. After sphincterotomy and common bile duct clearance the largest stone was retrieved for measurement. Endoscopic or surgical explorations of the common bile duct were considered the gold-standard methods for the diagnosis of choledocholithiasis. RESULTS: All 68 patients were submitted to laparoscopic cholecystectomy with intraoperative cholangiography with confirmation of the presence of gallstones. Endoscopic ultrassonography was a more sensitivity test than endoscopic retrograde cholangiography (97% vs. 67%) for the detection of choledocholithiasis. When stones >4.0 mm were analyzed, endoscopic ultrassonography and endoscopic retrograde cholangiography presented similar results (96% vs. 90%). Neither the size of the stone nor the common bile duct diameter had influence on endoscopic ultrasonographic performance. CONCLUSIONS: For a group of patients with an intermediate or moderate risk with respect to the likelihood of having common bile duct stones, endoscopic ultrassonography is a better test for the diagnosis of choledocholithiasis when compared to endoscopic retrograde cholangiography mainly for small-sized calculi.

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Endoscopic ultrasound image of hydatid membranes in the common bile duct

Digestive and Liver Disease ◽

10.1016/j.dld.2012.02.017 ◽

2012 ◽

Vol 44 (9) ◽

pp. e19 ◽

Cited By ~ 1

Author(s):

Francesco Azzolini ◽

Lorenzo Camellini ◽

Guido Menozzi ◽

Romano Sassatelli

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Endoscopic Ultrasound ◽

Ultrasound Image ◽

The Common

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Endoscopic ultrasound-guided biliary drainage in malignant distal obstruction of the common bile duct

Revista de Gastroenterología de México (English Edition) ◽

10.1016/j.rgmxen.2017.04.003 ◽

2018 ◽

Vol 83 (1) ◽

pp. 75-76

Author(s):

A. Membrillo-Romero ◽

M.L. Altamirano-Castañeda ◽

A. Muñoz-Bautista

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Endoscopic Ultrasound ◽

Biliary Drainage ◽

Ultrasound Guided ◽

Distal Obstruction ◽

The Common

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Surgical clips in the common bile duct suspected on endoscopic ultrasound and confirmed on endoscopic retrograde cholangiopancreatography

Endoscopic Ultrasound ◽

10.4103/2303-9027.117666 ◽

2013 ◽

Vol 2 (3) ◽

pp. 157 ◽

Cited By ~ 1

Author(s):

Malay Sharma ◽

Bhupender Singh ◽

Rosh Varghese

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Endoscopic Ultrasound ◽

Endoscopic Retrograde ◽

Surgical Clips ◽

The Common

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Endoscopic ultrasound-guided choledochoduodenostomy with electrocautery-enhanced lumen-apposing stents: a retrospective analysis

Endoscopy ◽

10.1055/a-0735-9137 ◽

2018 ◽

Vol 51 (06) ◽

pp. 540-547 ◽

Cited By ~ 16

Author(s):

Jeremie Jacques ◽

Jocelyn Privat ◽

Fabien Pinard ◽

Fabien Fumex ◽

Jean-Christophe Valats ◽

...

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Success Rate ◽

Endoscopic Ultrasound ◽

Biliary Drainage ◽

Clinical Success ◽

Endoscopic Drainage ◽

Technical Failure ◽

Ultrasound Guided ◽

The Common

Abstract Background Endoscopic ultrasound-guided biliary drainage is an alternative to percutaneous biliary drainage in cases of malignant biliary obstruction and failure of classic endoscopic drainage by endoscopic retrograde cholangiopancreatography (ERCP). Recently, a new electrocautery-enhanced lumen-apposing metal stent (ECE-LAMS) that allows for endoscopic anastomosis (apposition stent) has become available for use in EUS-choledochoduodenostomy (EUS-CDS) and facilitates the procedure. Methods This was a retrospective study of all EUS-CDS procedures performed in France between April 2016 and August 2017. The primary end point was the technical and clinical success rates of EUS-CDS using an ECE-LAMS. Results 52 consecutive patients were included in the study. The etiology of distal bile duct obstruction was distal pancreatic adenocarcinoma in 43 patients (82.7 %). The technical success rate was 88.5 % (46 /52 patients), and the clinical success rate was 100 % (46/46 patients). The mean duration of the procedure was 10.2 minutes (range 1 – 90). Two patients (3.8 %) presented with short-term complications after EUS-CDS and before discharge from hospital. In univariate analyses, a small diameter of the common bile duct and not following the recommended procedure technique were significant risk factors for technical failure. Over a mean follow-up of 157 days, the median survival time without biliary complications was 135 days. Conclusion EUS-CDS with an ECE-LAMS is efficacious and safe in distal malignant obstruction of the common bile duct and could be proposed as the first option in cases of ERCP failure.

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