Comparative Observation And Analysis Of Extracorporeal And Endoscopic Ultrasonic Diagnosis For Biliary Duct Diseases

Background:Diseases of biliary ducts are frequently in China. Ultrasonography is the optimal non-invasive means for the examination of biliary system. Although extracoporeal ultrasonography has the advantageo of higher sensitivity in diagnosis for biliary duct diseases, it is less reliable in etiological diagnosis, localization and circumscription of the pathological changes. Hence there's a number of doubtful patients need correct diagnosis. The diagnosis and treatment of biliary duct diseases have improved greatly by the combination of endoscopic ultrasonography (EUS) with other auxiliary diagnosis.Objective:To explore the worthiness of extracopeal ultrasound for diagnosis of biliary duct diseases and to study the effect of the combination of extracopeal and endoscopic ultrasonography on the etiological diagnosis, thus evaluate the value of EUS in improving the accuracy of the diagonis for biliary duct diseases.Materials and Methods:1. Retrospective research was performed and 342 patients were included. Extracorporeal ultrasound examinations were performed and inside diameters of different levels of biliary ducts were documented. The echoes of abnormal tissues in the biliary ducts and any thickening, dropsy, coarseness of the ducts, as well as any distension of main pancreatic duct were also explored. Occupying lesion in porta hepatic, head of pancreas, posterior peritoneum and the infiltration of the leision to the environmental organs were also explored.2.65 patients, who performed EUS examination because of indefinite diagnosis by the extracorporeal ultrasound examination, were retrospectively studied.25 performed EUS examination by water-filled balloon method in duodenum and 40 performed IDUS (intraductal ultrasonography) examination according to degasification-water immersing method in stomach respectively to obtain omnidirectional presentation of gallbladder and common bile duct. The images of doubtful part were comparatively presented by amplifying pictures and/or changing frequency. The endoscope was passed deeply into bile ducts or pancreatic ducts and the catheter was slipped into the ducts with the direct of guide wire according to endoscopic retrograde cholangiopancreatography (ERCP), a primary method of intraductal ultrasonography (IDUS).Results:1. The coincidence of extracorporeal ultrasound method was 88.01%. In the rest 11.99%patients,20 were missed diagnosed and 21 were missdiagnosed, amounting to 41 cases.15 patients who suffered gallstone were missdiagnosised.1 case of cholangiocarcinoma was misdiagnosed as chronic cholangitis. Among the 4 cases who were misdiagnosed as carcinoma of ampulla,2 were afflicted with chronic inflammation and 2 suffered from gallstone.2. EUS confirmed 9 common duct stones,2 small biliary calculi,4 carcinoma of head of pancreas,5 cholangiocarcinoma,2 carcinoma of duodenal papilla,2 inflammatory biliary stenosis. The EUS examination of 24 out of the 25 patients had been proved coincident with pathogical diagnosis and 1 case was missdiagnosed or missed diagnosed, with a coincidence of 96.00%. IDUS revealed 12 common duct stones,5 small biliary calculi,3 carcinoma of head of pancreas,5 cholangiocarcinoma, 1 carcinoma of duodenal papilla,1 stenosed papilla myotosis,3 inflammatory biliary stenosis,5 sclerosing cholangitis. The IDUS conclusions of 37 out of 40 patients were coincident with pathogical diagnosis, while 3 cases were missdiagnosed or missed diagnosed, resulting in a coincidence of 92.50%.Conclusions:Extracorporeal ultralsound could serve as the principal screening examination method due to simple manipulation, non-invasive, noe-irradiation, low cost. EUS examination could improve the accuracy of diagnosis and patients who have symptoms or physical signs of biliary diseases but without showing changes of extracorporeal ultrasound images may undergo EUS examination. The advantages of EUS include the combination of ultrasound and endoscope, the catherter entrying directly into the diseases part, being immune to the stenosed ducts and the size of the calculi, obtaining sharper images, et al. It values more in diagnosis for small biliary calculi, sclerosing cholangitis as well as pristine tumor. The mutual compementarity of extracorporeal and endoscopic ultrasound could improve the accuracy of diagnosis for biliary diseases, thus benefit earlier discovery of the diseases.