ERCP Combined With Intraductal Ultrasonography In The Diagnosis Of Bile Duct Stricture Diseases

Objective To evaluate the endoscopic retrogradecholangiopancreatography (ERCP) combined with intraductal ultrasonography(IDUS) in the diagnosis of bile duct stricture diseases.Methods A total of36cases of bile duct stricture were diagnosised byEUS, IDUS and ERCP in December2012to October2013; The findings byendoscopic ultrasonographyand, endoscopic retrogradecholangiopancreatography, intraductal ultrasonography and the result of the bileduct brushing cytology, the liquid-based cytology and the histopathologicalexamination were analyzed. The final diagnosis was base on clinical data,histopathology and follow-up results(≥6months).Results All of the36patients in whom21were diagnosed to bemalignant biliary diseases: among them9biliary tract carcinoma,4duodenalpapilla carcinoma,4pancreatic cancer infiltrated common bile duct,4cancer ofthe liver infiltrated common bile duct;15were diagnosed to be benign biliarydiseases:9bile duct stones,4liver fluke disease,1bile duct inflammatory stenosis,1external compression result in bile duct stricture. The accuracy rate ofthe EUS, ERCP, IDUS and ERCP+IDUS in the differential diagnosis of the bileduct stricture disease were77.8%,88.9%、91.7%and94.4%respectively. Theaccuracy rate of differential diagnosis of the bile duct stricture disease in ERCPwas significantly higher than EUS; And the accuracy rate of ERCP combinedwith IDUS was significantly higher than both EUS and ERCP (P<0.05). Thesensitivity, specificity, positive predictive value and negative predictive value ofERCP+IDUS were95.2%、93.3%、95.2%、93.3%respectively; The sensitivity,positive predictive value, negative predictive value in ERCP+IDUS were higherthan EUS, ERCP and IDUS. All of the36patients were carried out the bile ductbrushing cytology and the liquid-based cytology or histopathologicalexamination,19of them were diagnosed to be malignant biliary diseases, while17were diagnosed to be benign biliary diseases. The sensitivity, specificity andaccuracy of differential diagnosis of the bile duct stricture disease were90.5%,100%,94.4%respectively.Conclusion ERCP combined with IDUS can improve the diagnosticaccuracy of the bile duct disorders. IDUS was carried out guiding by the guidewire, and the operation was simple. It was also complement with EUS eachother. With the help of ERCP and IDUS, the bile duct could be targeted brush,which would more improve the diagnostic positive rate.