Transpapillary intraductal US prior to biliary drainage in the assessment of longitudinal spread of extrahepatic bile duct carcinoma

Background: The utility of intraductal US via the transpapillary route prio r to biliary drainage in the assessment of longitudinal extension of extrah epatic bile duct carcinoma was investigated. Methods: In 19 patients with extrahepatic bile duct carcinoma who underwent surgical resection, an ultrasonic probe (diameter, 2.0 mm; frequency, 20 M Hz) was inserted into the bile duct via the transpapillary route prior to b iliary drainage. Longitudinal cancer extension along the bile duct was pros pectively determined and compared with the histologic findings in the resec ted specimens. Results: Results on the hepatic side were as follows: Intraductal US demons trated more extensive longitudinal cancer spread than cholangiography in 9 of 19 patients with one instance of overdiagnosis. The accuracy of intraduc tal US in assessing the extent of spread (84%) was superior to that of chol angiography (47%) (p < 0.05), Results on the duodenal side were as follows: In patients with suprapancreatic bile duct cancer (n = 14), intraductal US demonstrated more extensive longitudinal cancer spread than cholangiograph y in 8 of 14 patients. The accuracy of intraductal US in assessing the exte nt of the spread (86%) was superior to that of cholangiography (43%) (p < 0 .05). Conclusions: Transpapillary intraductal US prior to biliary drainage is use ful in demonstrating longitudinal extension of bile duct cancer. However, t he surgical margins were inaccurate in some patients.