Role of radial endosonography in the diagnosis of acute cholangitis

Background and Study Aim: We aimed to assess radial endoscopic ultrasound (EUS) features of the bile duct wall as well as biliary luminal liquid characteristics in cases with acute cholangitis. Patients and Methods: This prospective study was performed during the period from January 2009 to February 2010 in a tertiary referral center. Twenty-eight patients with acute cholangitis and 60 patients without acute cholangitis but with cholestasis due to gallstone disease were enrolled in the study. During radial EUS examination, sonographic features of the common bile duct wall, the intraductal luminal content, and nearby periductal structures were investigated. Mild hyperechogenic-heterogenic appearances with waving-type movements without acoustic shadowing enclosing one-third of the common bile duct were noted as purulent materials. Results: EUS indicated an increased focal and/or diffuse concentric bile duct wall thickness (>1.5 mm) in 68 and 27% of the cases with and without acute cholangitis, respectively. The mean bile duct wall thickness was 1.9 mm (0.9-2.9 mm) and 1.1 mm (0.6-2.1 mm) in the study and control groups, respectively (P < 0.05). On EUS, a pericholedochal hypoechoic strand more than 1.5 cm in length was present in 13 of 28 patients with acute cholangitis (46%). It was less than 1 cm long in 11 cases without acute cholangitis (18%). Bile duct content with heterogenous dense echogenicity without acoustic shadowing was present in 18 patients (64%) with acute cholangitis and in two patients (3%) without cholangitis. Those 20 patients were successfully drained with a same-day endoscopic retrograde cholangiography (ERCP) procedure which confirmed purulent biliary content after sphincterotomy. Same-day ERCP revealed no purulent material drainage from the bile duct in the other eight patients without cholangitis. The accuracy and positive and negative predictivity of diffuse concentric wall thickening and a peribiliary hypoechoic strand of greater than 1.5 cm in length for a diagnosis of acute cholangitis were 91, 86.3, and 67.1%, and 76, 72, and 54%, respectively. For purulent material, the accuracy and positive and negative predictive values of EUS for acute cholangitis were noted to be 87, 93.3, and 82%, respectively. Conclusion: Through this study, it was concluded that EUS findings such as diffuse and/or concentric wall thickening of more than 1.5 mm and intraductal heterogenous echogenicity without acoustic shadowing are highly accurate and predictive for diagnosing acute cholangitis. © 2011 Springer Science+Business Media, LLC.

Yazar Alper E.
Unsal B.
Buyrac Z.
Baydar B.
Akca S.
Arslan F.
Ustundag Y.
Yayın Türü Article
Tek Biçim Adres https://hdl.handle.net/20.500.12628/7451
Tek Biçim Adres 10.1007/s10620-010-1552-3
Konu Başlıkları Acute cholangitis
Diagnosis
Endosonography
ERCP
Koleksiyonlar Araştırma Çıktıları | WoS | Scopus | TR-Dizin | PubMed | SOBİAD
Scopus İndeksli Yayınlar Koleksiyonu
WoS İndeksli Yayınlar Koleksiyonu
Dergi Adı Digestive Diseases and Sciences
Dergi Cilt Bilgisi 56
Dergi Sayısı 7
Sayfalar 2191 - 2196
Yayın Yılı 2011
Eser Adı
[dc.title]
Role of radial endosonography in the diagnosis of acute cholangitis
Yazar
[dc.contributor.author]
Alper E.
Yazar
[dc.contributor.author]
Unsal B.
Yazar
[dc.contributor.author]
Buyrac Z.
Yazar
[dc.contributor.author]
Baydar B.
Yazar
[dc.contributor.author]
Akca S.
Yazar
[dc.contributor.author]
Arslan F.
Yazar
[dc.contributor.author]
Ustundag Y.
Yayın Yılı
[dc.date.issued]
2011
Yayın Türü
[dc.type]
article
Özet
[dc.description.abstract]
Background and Study Aim: We aimed to assess radial endoscopic ultrasound (EUS) features of the bile duct wall as well as biliary luminal liquid characteristics in cases with acute cholangitis. Patients and Methods: This prospective study was performed during the period from January 2009 to February 2010 in a tertiary referral center. Twenty-eight patients with acute cholangitis and 60 patients without acute cholangitis but with cholestasis due to gallstone disease were enrolled in the study. During radial EUS examination, sonographic features of the common bile duct wall, the intraductal luminal content, and nearby periductal structures were investigated. Mild hyperechogenic-heterogenic appearances with waving-type movements without acoustic shadowing enclosing one-third of the common bile duct were noted as purulent materials. Results: EUS indicated an increased focal and/or diffuse concentric bile duct wall thickness (>1.5 mm) in 68 and 27% of the cases with and without acute cholangitis, respectively. The mean bile duct wall thickness was 1.9 mm (0.9-2.9 mm) and 1.1 mm (0.6-2.1 mm) in the study and control groups, respectively (P < 0.05). On EUS, a pericholedochal hypoechoic strand more than 1.5 cm in length was present in 13 of 28 patients with acute cholangitis (46%). It was less than 1 cm long in 11 cases without acute cholangitis (18%). Bile duct content with heterogenous dense echogenicity without acoustic shadowing was present in 18 patients (64%) with acute cholangitis and in two patients (3%) without cholangitis. Those 20 patients were successfully drained with a same-day endoscopic retrograde cholangiography (ERCP) procedure which confirmed purulent biliary content after sphincterotomy. Same-day ERCP revealed no purulent material drainage from the bile duct in the other eight patients without cholangitis. The accuracy and positive and negative predictivity of diffuse concentric wall thickening and a peribiliary hypoechoic strand of greater than 1.5 cm in length for a diagnosis of acute cholangitis were 91, 86.3, and 67.1%, and 76, 72, and 54%, respectively. For purulent material, the accuracy and positive and negative predictive values of EUS for acute cholangitis were noted to be 87, 93.3, and 82%, respectively. Conclusion: Through this study, it was concluded that EUS findings such as diffuse and/or concentric wall thickening of more than 1.5 mm and intraductal heterogenous echogenicity without acoustic shadowing are highly accurate and predictive for diagnosing acute cholangitis. © 2011 Springer Science+Business Media, LLC.
Kayıt Giriş Tarihi
[dc.date.accessioned]
2019-12-23
Açık Erişim Tarihi
[dc.date.available]
2019-12-23
Yayın Dili
[dc.language.iso]
eng
Konu Başlıkları
[dc.subject]
Acute cholangitis
Konu Başlıkları
[dc.subject]
Diagnosis
Konu Başlıkları
[dc.subject]
Endosonography
Konu Başlıkları
[dc.subject]
ERCP
Haklar
[dc.rights]
info:eu-repo/semantics/closedAccess
ISSN
[dc.identifier.issn]
0163-2116
İlk Sayfa Sayısı
[dc.identifier.startpage]
2191
Son Sayfa Sayısı
[dc.identifier.endpage]
2196
Dergi Adı
[dc.relation.journal]
Digestive Diseases and Sciences
Dergi Sayısı
[dc.identifier.issue]
7
Dergi Cilt Bilgisi
[dc.identifier.volume]
56
Tek Biçim Adres
[dc.identifier.uri]
https://dx.doi.org/10.1007/s10620-010-1552-3
Tek Biçim Adres
[dc.identifier.uri]
https://hdl.handle.net/20.500.12628/7451
Görüntülenme Sayısı ( Şehir )
Görüntülenme Sayısı ( Ülke )
Görüntülenme Sayısı ( Zaman Dağılımı )
Görüntülenme
67
09.12.2022 tarihinden bu yana
İndirme
1
09.12.2022 tarihinden bu yana
Son Erişim Tarihi
18 Mayıs 2024 19:11
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Tıklayınız
cholangitis without patients purulent respectively diffuse concentric content shadowing acoustic intraductal thickening heterogenous negative common positive echogenicity accuracy material and/or hypoechoic thickness length strand present radial endoscopic features predictive luminal biliary retrograde cholangiography accurate drained
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