Authors: Beom Jin Kim Pung Kang Jong Kyun Lee Dong Hyun Sinn Kwang Hyuck Lee Kyu Taek Lee Jong Chul Rhee Jae Hoon Lim
Publish Date: 2009/03/18
Volume: 55, Issue: 3, Pages: 836-841
Abstract
Background Intraductal ultrasonography IDUS is a useful procedure for diagnosing microlithiasis in the bile duct but it is not easy to differentiate between tiny echogenicity and real microlithiasis We compared the echogenicity seen on IDUS and the findings of bile microscopy BM of bile that was collected in the common bile duct CBD to determine whether the echogenicity seen on IDUS is real microlithiasis Methods This prospective study involved a total of 30 patients who experienced biliary pain n = 11 acute cholecystitis n = 11 or indeterminate pancreatitis n = 8 without a filling defect or obstruction in the bile duct IDUS was performed during endoscopic retrograde cholangiopancreatography ERCP followed by bile aspiration for BM Endoscopic sphincterotomy EST was performed if definite echogenic materials were observed on IDUS Results Of the 30 patients 23 77 had echogenic materials visible in the CBD on IDUS Of these 23 patients 13 57 were found to have biliary crystals by BM The size of the echogenic materials was the only significant factor associated with BM positivity Using the receiver operating curve the optimal size of the echogenicity to differentiate real microlithiasis was 14 mm Conclusions Optimal concordance between IDUS and BM was observed when the size of the microlithiasis was greater than 14 mm under these conditions the sensitivity and specificity were 71 and 75 respectively This information may be useful when deciding whether to perform endoscopic sphincterotomy
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