7021 Intraductal ultrasound (idus): experience in a us tertiary care center

Autor: Vipul H. Shah, Peter D. Stevens, Robert Dettmer, Floyd Byfield, Stavros N. Stavropoulos, Charles J. Lightdale
Rok vydání: 2000
Předmět:
Zdroj: Gastrointestinal Endoscopy. 51:AB246
ISSN: 0016-5107
DOI: 10.1016/s0016-5107(00)14692-9
Popis: Introduction: IDUS may be a useful adjunct to ERCP. Aim:To report our initial experience with this modality. Methods:We reviewed all IDUSs performed at our institution over the past 14 months. Results: Using the Olympus UM-3R 20 MHz and UM-2R 12 MHz probes,37 IDUSs were performed on 32 patients (17 M, 15 W) of mean age 67 yrs (50-89). Twentynine biliary, 7 pancreatic, 5 ampullary, and 1 intracystic IDUS were performed. Surgically altered anatomy was present in 5 patients (2 Billroth II, 1 liver transplantation, 1 distal pancreatectomy, 1 choledochojejunostomy). The bile duct (BD) was accessed via a native papilla (10), biliary sphincterotomy (ST) (14), surgical choledochojejunostomy (1), or metal stent (1). The pancreatic duct (PD) was accessed via a native papilla (1), biliary ST (2), pancreatic ST (1) or both (2). Eighteen malignancies and 14 benign conditions were imaged. The malignancies were 8 cholangiocarcinomas (CCAs), (1 intrahepatic, 2 proximal, 2 mid-duct, 3 distal), 2 ampullary adenocarcinomas (adCAs), 2 pancreatic intraductal papillary mucinous tumors (IPMTs), 3 metastatic cancers with BD strictures (1 gastric, 2 adCAs of unknown origin), and 3 pancreatic adCAs. Malignancy was established by surgery in 13 patients and by biopsy/cytology in 5. The benign conditions were ampullary fibrosis/papillary stenosis (7), stones/sludge (7), postoperative PD stricture with communicating pseudocyst (1), PD stricture in chronic pancreatitis (1), periampullary cyst (1), normal duct (1). Malignant lesions imaged by IDUS consisted of masses (4), mural-based nodules (2 CBD, 1 CHD), strictures (7 CBD, 2 CHD, 2 PD),and mucin, mural nodules and epithelial projections in the IPMTs. Of the 18 malignancies, 15 had surgically confirmed vascular staging. Vascular involvement was correctly predicted in 2 cases and correctly excluded in 13 cases. Benign lesions imaged by IDUS included sludge/stones (7), PD strictures (2), hyperechoic areas in pancreatic parenchyma (in the one case with chronic pancreatitis). Malignant strictures appeared as thickened hypoechoic areas that obliterated the duct layers present in normal duct segments. Nodules and mural masses appeared hypoechoic with heterogeneous echotexture in the larger masses. Stones and sludge were highly echogenic.In 6 out of the 7 cases of stones/sludge the diagnosis had not been established during ERCP. Conclusion: IDUS delineates normal wall layers and their effacement in malignant strictures and is accurate for vascular staging and the detection of small stones and sludge.
Databáze: OpenAIRE
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