Clin Endosc.  2012 Sep;45(3):331-336.

Usefulness of Intraductal Ultrasonography in the Diagnosis of Cholangiocarcinoma and IgG4-Related Sclerosing Cholangitis

• Nakazawa T
• Naitoh I
• Hayashi K

Abstract

The technique of intraductal ultrasonography (IDUS) of the bile duct with a thin-caliber probe and a ropeway system has provided excellent images of the bile duct and periductal structures and is an easy transpapillary approach. In addition, once the guide wire is inserted into the bile duct, IDUS and transpapillary biopsy after endoscopic retrograde cholangiopancreatography can be performed in a single session. Here, we review the usefulness of IDUS in the diagnosis of cholangiocarcinoma and IgG4-related sclerosing cholangitis.

Keyword

Intraductal ultrasonography; Cholangiocarcinoma; IgG4-related sclerosing cholangitis

MeSH Terms

Bile Ducts
Biopsy
Cholangiocarcinoma
Cholangiopancreatography, Endoscopic Retrograde
Cholangitis, Sclerosing

Figure

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  Fig. 1 Imagings of intraductal ultrasonography (IDUS) and cholangiogram of cholangiocarcinoma (infiltrating type). Cholagiogram showing stenosis in the hepatic hilum. (A) IDUS showing irrgular hypoechoic mass. (B) IDUS showing invasion to right hepatic artery. (C) IDUS showing irregular hypoechoic mass at the bifurcation of hepatic ducts. (D) No mass at the biurcation of B4. (E) IDUS showing heterogenous thickened wall in the middle of common bile duct.

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  Fig. 2 Useful modalities in the diagnosis of IgG4-related sclerosing cholangitis based on shematic classification of cholangiogram. EUS-FNA, endoscopic ultrasonography-guided fine needle aspiration; UC, ulcerative colitis; IDUS, intraductal ultrasonography.

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  Fig. 3 Comparison of intraductal ultrasonography findings between IgG4-related sclerosing cholangitis and cholangiocarcinoma.

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  Fig. 4 Imagings of IgG4-related sclerosing cholangitis. (A) Endoscopic retrograde pancreatography with balloon catheter showing slight irregularities at the head of pancreas. (B) Abdominal computed tomography showing atrophic pancreas. (C) Endoscopic retrograde cholangiography (ERC) showing strictures in the both hepatic ducts at the hepatic hilum. Intraductal ultrasonography showing the homogeneous wall thickness with the size of 3.2 mm at the stenotic lesion of ERC (Ca) and with the size of 2.0 mm at the non-stenotic lesion of ERC (Cb).

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