UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Intraductal ultrasound of the pancreaticobiliary ductal system

Authors
Michael J Levy, MD
Maurits J Wiersema, MD
Section Editor
Douglas A Howell, MD, FASGE, FACG
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF

INTRODUCTION

The development of endoscopic ultrasound (EUS) in the early 1980s overcame some of the limitations of transabdominal ultrasound for imaging the gastrointestinal tract wall and retroperitoneum [1]. One of the advantages of EUS is the ability to apply the ultrasound transducer directly against the luminal surface, which minimizes intervening adipose tissue and air between the transducer and the target tissue, thereby enhancing image quality. The proximity of the transducer to the target tissue also permits the use of higher frequency ultrasound, which further contributes to the enhanced image resolution. As a result, EUS is used routinely in the evaluation of numerous gastrointestinal disorders, including the diagnosis and staging of gastrointestinal tumors. (See appropriate topic reviews.)

The technical evolution of EUS has lead to the development of small caliber intraductal ultrasound (IDUS) miniprobes (about 2 mm), which can be passed through standard endoscopes directly into the bile or pancreatic duct (picture 1). The small caliber, flexibility, and excellent image quality produced by these catheters makes them ideal for evaluating a variety of biliary and pancreatic disorders (table 1).

This topic review will provide an overview of the role of IDUS in the evaluation of several pancreatic and hepatobiliary disorders. The role of standard EUS instruments in the evaluation of these conditions is presented separately. (See appropriate topic reviews.) The role of miniprobes for evaluation of other parts of the gastrointestinal tract is also discussed elsewhere. (See "High-frequency catheter endoscopic ultrasonography".)

TECHNICAL CONSIDERATIONS

Intraductal ultrasound (IDUS) is capable of producing better image resolution than standard endoscopic ultrasound (EUS; 0.07 to 0.18 mm) [2-4]. Acoustic coupling is optimized by the tubular anatomy of the pancreatic and bile ducts, which are fluid filled and only slightly larger in caliber than the probe itself. In addition, the probes operate at higher frequencies (12 to 30 MHz) than standard EUS, which leads to higher image resolution.

Three systems are available to perform IDUS (table 2):

                       

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Mon Aug 15 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. DiMagno EP, Buxton JL, Regan PT, et al. Ultrasonic endoscope. Lancet 1980; 1:629.
  2. Crowley RJ, von Behren PL, Couvillon LA Jr, et al. Optimized ultrasound imaging catheters for use in the vascular system. Int J Card Imaging 1989; 4:145.
  3. Martin RW, Silverstein FE, Kimmey MB. A 20-MHz ultrasound system for imaging the intestinal wall. Ultrasound Med Biol 1989; 15:273.
  4. Silverstein FE, Martin RW, Kimmey MB, et al. Experimental evaluation of an endoscopic ultrasound probe: in vitro and in vivo canine studies. Gastroenterology 1989; 96:1058.
  5. Tamada K, Ido K, Ueno N, et al. Assessment of hepatic artery invasion by bile duct cancer using intraductal ultrasonography. Endoscopy 1995; 27:579.
  6. Tamada K, Ido K, Ueno N, et al. Assessment of portal vein invasion by bile duct cancer using intraductal ultrasonography. Endoscopy 1995; 27:573.
  7. Tamada K, Ido K, Ueno N, et al. Preoperative staging of extrahepatic bile duct cancer with intraductal ultrasonography. Am J Gastroenterol 1995; 90:239.
  8. Tamada K, Ueno N, Ichiyama M, et al. Assessment of pancreatic parenchymal invasion by bile duct cancer using intraductal ultrasonography. Endoscopy 1996; 28:492.
  9. Kuroiwa M, Goto H, Hirooka Y, et al. Intraductal ultrasonography for the diagnosis of proximal invasion in extrahepatic bile duct cancer. J Gastroenterol Hepatol 1998; 13:715.
  10. Noda T, Ido K, Ueno N. Transpapillary intraductal ultrasonography (IDUS) of the bile duct without sphincterotomy. Ultrasound Int 1995; 1:141.
  11. Tamada K, Nagai H, Yasuda Y, et al. Transpapillary intraductal US prior to biliary drainage in the assessment of longitudinal spread of extrahepatic bile duct carcinoma. Gastrointest Endosc 2001; 53:300.
  12. Menzel J, Domschke W. Intraductal ultrasonography (IDUS) of the pancreato-biliary duct system. Personal experience and review of literature. Eur J Ultrasound 1999; 10:105.
  13. Vazquez-Sequeiros E, Baron TH, Clain JE, et al. Evaluation of indeterminate bile duct strictures by intraductal US. Gastrointest Endosc 2002; 56:372.
  14. Ascher SM, Evans SR, Goldberg JA, et al. Intraoperative bile duct sonography during laparoscopic cholecystectomy: experience with a 12.5-MHz catheter-based US probe. Radiology 1992; 185:493.
  15. Menzel J, Poremba C, Dietl KH, Domschke W. Preoperative diagnosis of bile duct strictures--comparison of intraductal ultrasonography with conventional endosonography. Scand J Gastroenterol 2000; 35:77.
  16. Fujita N, Noda Y, Kobayashi G, et al. Staging of bile duct carcinoma by EUS and IDUS. Endoscopy 1998; 30 Suppl 1:A132.
  17. Furukawa T, Naitoh Y, Tsukamoto Y, et al. New technique using intraductal ultrasonography for the diagnosis of diseases of the pancreatobiliary system. J Ultrasound Med 1992; 11:607.
  18. Kuroiwa M, Tsukamoto Y, Naitoh Y, et al. New technique using intraductal ultrasonography for the diagnosis of bile duct cancer. J Ultrasound Med 1994; 13:189.
  19. Kikuchi Y, Tsuyuguchi T, Saisho H. Evaluation of normal bile duct and cholangitis by intraductal ultrasonography. Abdom Imaging 2008; 33:452.
  20. Fujita N, Noda Y, Kobayashi G. Analysis of the layer structure of the gallbladder wall delineated by endoscopic ultrasound using the pinning method. Dig Endosc 1995; 7:353.
  21. Noda Y, Fujita N, Kobayashi G, et al. [Comparison of echograms by a microscanner and histological findings of the common bile duct, in vitro study]. Nihon Shokakibyo Gakkai Zasshi 1997; 94:172.
  22. Tamada K, Kanai N, Ueno N, et al. Limitations of intraductal ultrasonography in differentiating between bile duct cancer in stage T1 and stage T2: in-vitro and in-vivo studies. Endoscopy 1997; 29:721.
  23. Das A, Isenberg G, Wong RC, et al. Wire-guided intraductal US: an adjunct to ERCP in the management of bile duct stones. Gastrointest Endosc 2001; 54:31.
  24. Ueno N, Nishizono T, Tamada K, et al. Diagnosing extrahepatic bile duct stones using intraductal ultrasonography: a case series. Endoscopy 1997; 29:356.
  25. Tseng LJ, Jao YT, Mo LR, Lin RC. Over-the-wire US catheter probe as an adjunct to ERCP in the detection of choledocholithiasis. Gastrointest Endosc 2001; 54:720.
  26. Catanzaro A, Pfau P, Isenberg GA, et al. Clinical utility of intraductal US for evaluation of choledocholithiasis. Gastrointest Endosc 2003; 57:648.
  27. Haber GB. Is seeing believing? Gastrointest Endosc 2003; 57:712.
  28. Tio TL, Cheng J, Wijers OB, et al. Endosonographic TNM staging of extrahepatic bile duct cancer: comparison with pathological staging. Gastroenterology 1991; 100:1351.
  29. Rösch T, Lorenz R, Braig C, Classen M. Endoscopic ultrasonography in diagnosis and staging of pancreatic and biliary tumors. Endoscopy 1992; 24 Suppl 1:304.
  30. Tamada K, Ueno N, Tomiyama T, et al. Characterization of biliary strictures using intraductal ultrasonography: comparison with percutaneous cholangioscopic biopsy. Gastrointest Endosc 1998; 47:341.
  31. Farrell RJ, Agarwal B, Brandwein SL, et al. Intraductal US is a useful adjunct to ERCP for distinguishing malignant from benign biliary strictures. Gastrointest Endosc 2002; 56:681.
  32. Domagk D, Wessling J, Reimer P, et al. Endoscopic retrograde cholangiopancreatography, intraductal ultrasonography, and magnetic resonance cholangiopancreatography in bile duct strictures: a prospective comparison of imaging diagnostics with histopathological correlation. Am J Gastroenterol 2004; 99:1684.
  33. Tischendorf JJ, Meier PN, Schneider A, et al. Transpapillary intraductal ultrasound in the evaluation of dominant bile duct stenoses in patients with primary sclerosing cholangitis. Scand J Gastroenterol 2007; 42:1011.
  34. Levy MJ, Baron TH, Clayton AC, et al. Prospective evaluation of advanced molecular markers and imaging techniques in patients with indeterminate bile duct strictures. Am J Gastroenterol 2008; 103:1263.
  35. Gress F, Chen YK, Sherman S, et al. Experience with a catheter-based ultrasound probe in the bile duct and pancreas. Endoscopy 1995; 27:178.
  36. Tamada K, Tomiyama T, Ichiyama M, et al. Influence of biliary drainage catheter on bile duct wall thickness as measured by intraductal ultrasonography. Gastrointest Endosc 1998; 47:28.
  37. Brambs HJ. [Intraductal ultrasound of the bile ducts]. Radiologe 1993; 33:385.
  38. Tamada K, Ido K, Ueno N, et al. Assessment of the course and variations of the hepatic artery in bile duct cancer by intraductal ultrasonography. Gastrointest Endosc 1996; 44:249.
  39. Yasuda K, Mukai H, Nakajima M, Kawai K. Clinical application of ultrasonic probes in the biliary and pancreatic duct. Endoscopy 1992; 24 Suppl 1:370.
  40. Tamada K, Kanai N, Tomiyama T, et al. Prediction of the histologic type of bile duct cancer by using intraductal ultrasonography. Abdom Imaging 1999; 24:484.
  41. Hayashi S, Miyazaki M, Kondo Y, Nakajima N. Invasive growth patterns of hepatic hilar ductal carcinoma. A histologic analysis of 18 surgical cases. Cancer 1994; 73:2922.
  42. Nimura Y, Kamiya J. Cholangioscopy. Endoscopy 1998; 30:182.
  43. Sato M, Inoue H, Ogawa S, et al. Limitations of percutaneous transhepatic cholangioscopy for the diagnosis of the intramural extension of bile duct carcinoma. Endoscopy 1998; 30:281.
  44. Tamada K, Kurihara K, Tomiyama T, et al. How many biopsies should be performed during percutaneous transhepatic cholangioscopy to diagnose biliary tract cancer? Gastrointest Endosc 1999; 50:653.
  45. Tamada K, Yasuda Y, Nagai H, et al. Limitation of cholangiography in assessing longitudinal spread of extrahepatic bile duct carcinoma to the hepatic side. J Gastroenterol Hepatol 1999; 14:691.
  46. Yamaguchi K, Chijiiwa K, Saiki S, et al. Carcinoma of the extrahepatic bile duct: mode of spread and its prognostic implications. Hepatogastroenterology 1997; 44:1256.
  47. Tamada K, Tomiyama T, Oohashi A, et al. Bile duct wall thickness measured by intraductal US in patients who have not undergone previous biliary drainage. Gastrointest Endosc 1999; 49:199.
  48. Guibaud L, Bret PM, Reinhold C, et al. Bile duct obstruction and choledocholithiasis: diagnosis with MR cholangiography. Radiology 1995; 197:109.
  49. Karsten TM, Coene PP, van Gulik TM, et al. Morphologic changes of extrahepatic bile ducts during obstruction and subsequent decompression by endoprosthesis. Surgery 1992; 111:562.
  50. Palazzo L, Roseau G, Gayet B, et al. Endoscopic ultrasonography in the diagnosis and staging of pancreatic adenocarcinoma. Results of a prospective study with comparison to ultrasonography and CT scan. Endoscopy 1993; 25:143.
  51. Takayama T, Suma H, Wanibuchi Y, et al. Doppler miniprobe to measure arterial graft flow in coronary artery bypass grafting. Ann Thorac Surg 1991; 52:322.
  52. Furukawa T, Oohashi K, Yamao K, et al. Intraductal ultrasonography of the pancreas: development and clinical potential. Endoscopy 1997; 29:561.
  53. Furukawa T, Tsukamoto Y, Naitoh Y, et al. Differential diagnosis between benign and malignant localized stenosis of the main pancreatic duct by intraductal ultrasound of the pancreas. Am J Gastroenterol 1994; 89:2038.
  54. Furukawa T, Tsukamoto Y, Naitoh Y, et al. Evaluation of intraductal ultrasonography in the diagnosis of pancreatic cancer. Endoscopy 1993; 25:577.
  55. Inui K, Nakazawa S, Yoshino J, et al. Endoscopy and intraductal ultrasonography. Semin Surg Oncol 1998; 15:33.
  56. Menzel J, Domschke W. Intraductal ultrasonography may localize islet cell tumours negative on endoscopic ultrasound. Scand J Gastroenterol 1998; 33:109.
  57. Menzel J, Foerster EC, Domschke W. Intraductal ultrasound (IDUS) of the pancreas - Technique and diagnostic promise. Gut 1992; 33:S34.
  58. Bergman JJ, Rauws EA, Fockens P, et al. Randomised trial of endoscopic balloon dilation versus endoscopic sphincterotomy for removal of bileduct stones. Lancet 1997; 349:1124.
  59. Mukai H, Yasuda K, Nakajima M. Differential diagnosis of mucin-producing tumors of the pancreas by intraductal ultrasonography and peroral pancreatoscopy. Endoscopy 1998; 30 Suppl 1:A99.
  60. Taki T, Goto H, Naitoh Y, et al. Diagnosis of mucin-producing tumor of the pancreas with an intraductal ultrasonographic system. J Ultrasound Med 1997; 16:1.
  61. Furukawa T, Tsukamoto Y, Naitoh Y. New endoscopic approach to diagnosing pancreatic diseases using an intraductal ultrasound system. Dig Endosc 1993; 4:18.
  62. Procacci C, Biasiutti C, Carbognin G, et al. Characterization of cystic tumors of the pancreas: CT accuracy. J Comput Assist Tomogr 1999; 23:906.
  63. Le Borgne J, de Calan L, Partensky C. Cystadenomas and cystadenocarcinomas of the pancreas: a multiinstitutional retrospective study of 398 cases. French Surgical Association. Ann Surg 1999; 230:152.
  64. Inui K, Nakazawa S, Yoshino J, et al. Mucin-producing tumor of the pancreas--intraluminal ultrasonography. Hepatogastroenterology 1998; 45:1996.
  65. Hara T, Yamaguchi T, Ishihara T, et al. Diagnosis and patient management of intraductal papillary-mucinous tumor of the pancreas by using peroral pancreatoscopy and intraductal ultrasonography. Gastroenterology 2002; 122:34.
  66. Itoh A, Tsukamoto Y, Naitoh Y, et al. Intraductal ultrasonography for the examination of duodenal papillary region. J Ultrasound Med 1994; 13:679.
  67. Chak A, Isenberg G, Kobayashi K, et al. Prospective evaluation of an over-the-wire catheter US probe. Gastrointest Endosc 2000; 51:202.
  68. Itoh A, Goto H, Naitoh Y, et al. Intraductal ultrasonography in diagnosing tumor extension of cancer of the papilla of Vater. Gastrointest Endosc 1997; 45:251.
  69. Menzel J, Hoepffner N, Sulkowski U, et al. Polypoid tumors of the major duodenal papilla: preoperative staging with intraductal US, EUS, and CT--a prospective, histopathologically controlled study. Gastrointest Endosc 1999; 49:349.