Clinical usefulness of intraductal ultrasonography for the management of acute biliary pancreatitis
Article first published online: 10 APR 2015
© 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd
Journal of Gastroenterology and Hepatology
Volume 30, Issue 5, pages 952–956, May 2015
How to Cite
Yoon, L. Y., Moon, J. H., Choi, H. J., Kim, D. C., Seo, J. Y., Lee, T. H., Cha, S.-W., Cho, Y. D., Park, S.-H. and Kim, S.-J. (2015), Clinical usefulness of intraductal ultrasonography for the management of acute biliary pancreatitis. Journal of Gastroenterology and Hepatology, 30: 952–956. doi: 10.1111/jgh.12339
- Issue published online: 10 APR 2015
- Article first published online: 10 APR 2015
- Accepted manuscript online: 22 JUL 2013 05:12AM EST
- Manuscript Accepted: 25 JUN 2013
- biliary pancreatitis;
- endoscopic retrograde cholangiopancreatography;
- intraductal ultrasonography
Background and Aim
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.
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.
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.
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.