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intraductal ultrasonography and endoscopic retrograde cholangiography in diagnosis of extrahepatic bile duct stones: a comparative study

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Hepatobiliary & Pancreatic Diseases International 2004年第1期3卷 129-132页

作者： En-Qiang Linghu, Liu-Fang Cheng, Xiang-Dong Wang, Zhi-Qiang Wang, Yun-Sheng Yang, Wen Li, Feng-Chun Cai, Hong-Zhi Wang, Hong Du and Jiang-Yun Meng Beijing, China Department of Digestive Medicine, 301 Hospital, Beijing 100853, China Department of Digestive Medicine 301 Hospital Beijing 100853 China. lh_ eq@***

BACKGROUND: intraductal ultrasonography (IDUS) is highly accurate in detection of extrahepatic bile duct stones. This study was to compare the accuracy of IDUS and endo- scopic retrograde cholangiography (ERC) in the diagnosis of extrahepatic bile duct stones. METHODS: Thirty patients suspected of extrahepatic bile duct stones on B ultrasonography, CT, or MRI were en- rolled for study. ERC was performed using a Fujinon duo- denoscope (ED-410XT, ED-410Xu), then IDUS was done by inserting a Fujinon microprobe (PL2220-15) through the endoscopic biopsy channel to detect the extrahepatic bile duct. Finally stones in the extrahepatic bile duct were detected and extracted by endoscopic sphincterotomy (EST). RESULTS: Among the 30 patients, 26 were diagnosed as having cholelithiasis accurately through ERC. In one pa- tient the stone detected by ERC was really floccule. Mis- diagnosis happened in 2 patients with extrahepatic bile duct stones. So the overall accuracy and sensitivity of ERC in the diagnosis of extrahepatic bile duct stones were 86.7% (26/30) and 92.9% (26/28) respectively. In contrast, IDUS showed the results of diagnosis were in consistent with those of EST stone extraction. Its accuracy and sensi- tivity in the diagnosis of extrahepatic bile duct stones were 100% (30/30) and 100% (28/28) respectively. CONCLUSION: IDUS which is superior to ERC in diagno- sing extrahepatic bile duct stones can avoid the visual error of ERC.

关键词： endoscopic retrograde cholangiography intraductal ultrasonography extrahepatic bile duct stones

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Screening for hilar biliary invasion in ampullary cancer patients

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World Journal of Gastrointestinal Endoscopy 2022年第9期14卷 536-546页

作者： Tadayuki Takagi Mitsuru Sugimoto Rei Suzuki Naoki Konno Hiroyuki Asama Yuki Sato Hiroki Irie Jun Nakamura Mika Takasumi Minami Hashimoto Tsunetaka Kato Ryoichiro Kobashi Takumi Yanagita Yuko Hashimoto Shigeru Marubashi Takuto Hikichi Hiromasa Ohira Department of Gastroenterology Fukushima Medical UniversityFukushima 960-1295Japan Department of Endoscopy Fukushima Medical University HospitalFukushima 960-1295Japan Department of Pathological Diagnosis Fukushima Medical UniversityFukushima 960-1295Japan Department of Hepato-Biliary-Pancreatic and Transplant Surgery Fukushima Medical UniversityFukushima 960-1295Japan

BACKGROUND The treatment for ampullary cancer is pancreatoduodenectomy or local ***,effective methods for the preoperative investigation of hilar biliary invasion in ampullary cancer patients have not yet been *** To determine the necessity of and an appropriate method for investigating hilar biliary invasion of ampullary *** Among 43 ampullary cancer patients,34 underwent endoscopic treatment(n=9)or surgery(n=25).The use of imaging findings(thickening and enhancement of the bile duct wall on contrast-enhanced computed tomography,irregularity on endoscopic retrograde cholangiography,thickening of the entire bile duct wall on intraductal ultrasonography(IDUS),and partial thickening of the bile duct wall on IDUS)and biliary biopsy results for diagnosing hilar biliary invasion of ampullary cancer was *** Hilar invasion was not observed in every *** the patients who did not undergo biliary stent insertion,the combination of partial thickening of the bile duct wall on IDUS and biliary biopsy results showed the highest accuracy(100%)for diagnosing hilar biliary ***,each imaging method and biliary biopsy yielded some false-positive *** Although some false-positive results were obtained with each method,the combination of partial thickening of the bile duct wall on IDUS and biliary biopsy results was useful for diagnosing hilar biliary invasion of ampullary ***,hilar invasion of ampullary cancer is rare;therefore,the investigation of hilar biliary invasion of ampullary cancer might be unnecessary.

关键词： Ampullary cancer Biliary biopsy Contrast-enhanced CT Hilar biliary invasion intraductal ultrasonography

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Advances in the diagnosis and treatment of Ig G4-related sclerosing cholangitis: a review

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Oncology and Translational Medicine 2015年第6期1卷 243-248页

作者： Shunda Du Gang Liu Yilei Mao Department of Liver Surgery Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College

Immunoglobulin G4-related sclerosing cholangitis （IgG4-SC） is an IgG4-related disease characterized by bile duct fibroinflammatory wall-thickening and stenosis, resulting in obstruction jaundice, weight loss. Dif- ferent regions of the bile duct can be involved, with the distal region being the most common. IgG4-SC can also have other organ involvement, such as the pancreas, urinary tract, salivary glands and lacrimal glands. In clinical practice, the manifestation of IgG4-SC is very similar to cholangiocarcinoma （CC） and primary sclerosing cholangiUs （PSC）, as well as pancreatic malignancies, while the treatment and prognosis are totally different. Japanese researchers ever established the clinical diagnostic criteria in 2012：（1） charac- teristic biliary imaging findings; （2） elevated serum IgG4 concentrations; （3） the coexistence of IgG4-related diseases except those of the biliary tract; and （4） characteristic histopathological features. According to our observations, IgG4-SC can be distinguished from CC with 100% specificity only at a cutoff of six times the upper normal limit. Imaging findings have low specificity for diagnosis, with the exception of intraductal ultrasonography, which can reflect the lesion with relatively high specificity. IgG4 plasma cell infiltration can be found in bile duct biopsy tissue, although this procedure is difficult. According to recent studies, the treatment of IgG4-SC relies mainly on corticosteroids. Following steroid treatment, most IgG4-SC patients can recover and their symptoms are resolved although a few patients relapse after steroid withdrawal. Maintenance of steroid therapy or alternative drugs is necessary in such cases. There is, however, no stronq evidence for malignant transformation in I qG4-SC.

关键词： Immunoglobulin G4 (IgG4) sclerosing cholangitis (SC) jaundice intraductal ultrasonography steroid treatment

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