Clin Endosc.  2023 Mar;56(2):164-168. 10.5946/ce.2022.184.

Intraductal ultrasonography for biliary strictures

• Cheon YK

• KMID: 2540731
• DOI: http://doi.org/10.5946/ce.2022.184

Abstract

When diagnosing the nature of biliary strictures, it is sometimes difficult to perform non-invasive methods such as ultrasound, spiral computed imaging, magnetic resonance imaging, or endoscopic ultrasonography. Thus, treatment decisions are usually based on biopsy results. However, brush cytology or biopsy, which is widely used for biliary stenosis, has limitations owing to its low sensitivity and negative predictive value for malignancy. Currently, the most accurate method is bile duct tissue biopsy under direct cholangioscopy. On the other hand, intraductal ultrasonography administered under the guidance of a guidewire has the advantages of easy administration and being less invasive, allowing for adequate examination of the biliary tract and surrounding organs. This review discusses the usefulness and drawbacks of intraductal ultrasonography for biliary strictures.

Keyword

Biliary stricture; Cholangioscopy; Intraductal ultrasonography

Figure

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  Fig. 1. A thin caliber intraductal ultrasonic probe. The diameter of the transducer (UM-G20-29R; Olympus Co., Ltd.) is 2.4 mm, the frequency is 20 MHz, the axial resolution is 0.1 mm, and the maximum transmission distance is about 20 mm.

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  Fig. 2. Intraductal ultrasound image of normal bile duct wall. The inner hypoechoic layer is a fibromuscular structure (white arrow), and the outer hyperechoic layer is perimuscular connective tissue (black arrow).

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  Fig. 3. Malignant biliary stricture in intraductal ultrasonography showing an eccentric bile duct wall thickening and disruption of the normal bile duct wall arrows). T, tumor.

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  Fig. 4. T staging by the intraductal ultrasonography. (A) T1. The tumor is confined to the fibromuscular layer in the bile duct wall (white arrows). (B) T2. The tumor invades into the perimuscular connective tissue and interrupts the outer margin of the bile duct (white arrow). (C) T3. The tumor invades into adjacent blood vessels (white arrows). T, tumor; PV, portal vein.

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  Fig. 5. Klatskin tumor, Bismuth type II. (A, B) Endoscopic retrograde cholangiopancreatography and magnetic retrograde cholangiopancreatography revealed narrowing of the common hepatic duct and preservation of bifurcation. (C) Intraductal ultrasonography of the common hepatic duct showed an eccentric tumor mass. (D) The intraductal ultrasonography image showed that the tumor did not invade the surrounding vessels. T, tumor; CHD, common hepatic duct; HA, hepatic artery; PV, portal vein.

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  Fig. 6. Positive sign of vascular invasion by intraductal ultrasonography showing the disappearance of the high-echoic layer between the tumor and a vessel (white arrows).

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