COMMON BILE-DUCT DILATATION - THE CONTRIB UTION OF ENDOSCOPIC ULTRASOUND

In a prospective study 20 patients (14 women, 6 men; mean age 62 31-8 1 years) with extrahepatic obstructive jaundice (n = 15) or common bi le duct dilatation (CBD) without cholestasis (n = 5) were investigated by endoscopic ultrasound (EUS). All these patients underwent negative transabdominal ultrasonography (US) (n = 20) and computed tomography (CT) (n = 16). Inclusion criterion was a dilatation of the CBD of >7 m m or >10 mm in patients with previous cholecystectomy. The definitive diagnosis of a tumor (n = 8), choledocholithiasis (n = 7), stone migra tion (n = 1), choledochocele (n = 2) or slight dilatation of the CBD w ithout obstruction (n = 2) was confirmed by endoscopic retrograde chol angiopancreatography (ERCP) (n = 13), percutaneous transhepatic cholan giography (PTC) (n = 2), intraoperative cholangiography (n = 1) and fo llow up (n = 4; mean 21 3-36 mo.). Dilatation of the CBD could be de monstrated in all cases by EUS. Common bile duct stones (2-15 mm) were demonstrated by EUS in every case. CBD dilatation without underlying obstruction was correctly identified by EUS in all patients and confir med by further clinical and laboratory findings as well as EUS and ERC P (n = 1). EUS correctly described the localization of a malignant obs truction (n = 8) as confirmed by ERCP/PTC. All tumors (pancreatic head carcinoma n = 3, periampullary tumor (n = 5) could be visualized by E US. The diagnosis was confirmed by surgery (n = 5) or ultrasound guide d fine needle puncture (FNP) after a bile duct prosthesis had been pla ced (n = 3). Demonstrating the prosthesis by ultrasound allowed the pu ncture of suspected tumor. The local tumorstaging (T-staging) was corr ectly determined by EUS in 5 surgically confirmed tumors (4 T-1-tumors , 1 T-2-tumor). EUS is superior to US and CT in determining pancreatob iliary obstruction and allows reliable local tumor staging, in contras t to ERCP.