⁎4628 Intraductal ultrasound combined with ercp: is there a diagnostic advantage in pancreato-biliary disease?

Aim: Intraductal ultrasound (IDUS) is a new diagnostic technique for lesions of the pancreato-biliary tract. The benefit over the gold standard ERCP has yet to be defined. The present study reports our preliminary results. Methods: Two EUS-experienced endoscopists performed IDUS of the biliary tract in selected patients with expected diagnostic benefit from ultrasonography. IDUS was performed as co-examination with ERCP after opacification of the common bile duct (CBD) with contrast media as acoustical interface. A 20MHz Miniprobe (Olympus UM-G20-29R) was inserted through the working channel of a duodenoscope (Olympus JF 1T20). We focused on technical feasibility as well as on diagnostic information of IDUS. All patients records were reviewed and classified based on their clinical impact on further examinations. Results: Between March and October 1999 IDUS was performed in addition to ERCP in sixteen patients (5 male, median age 62y [32-79]). The average time of examination for IDUS was 14,2 minutes [7-24]. In eleven patients (69%) IDUS had a direct impact on clinical decisions: In five patients either sludge or gallstones could be localized, which were not detected by ERCP and papillotomy was performed. In two patients with a history of symptomatic cholelithiasis and normal MP-EUS without sludge, papillotomy was definitely not performed and the patients were referred to cholecystectomy. Three benign and one malignant CBD-stenosis could be identified: Twice a papillitis stenosans was suspected and confirmed by cytology. In one patient with history of acute pancreatitis sludge or gallstones could be excluded and no papillotomy was performed. Once a suspected cystic duct stone could be excluded due to an irregular wall structure which proved to be a cholangiocarcinoma. Of the remaining five patients without benefit, one was because of a technical problem of the Miniprobe. In four patients the results of ERCP could be confirmed but no additional information was achieved. In one of these, a cystic lesion in the head of the pancreas was better visualized but IDUS had no further advantage. Conclusion: Intraductal ultrasound (IDUS) is a new diagnostic imaging technique for intra- and extraluminal lesions of the pancreato-biliary tract. Our results suggest that IDUS is a valuable tool and is complementary to ERCP allowing to obtain relevant supplementary information in selected clinical situations.