Ecografia endoluminale delle vie biliari

We report our 4 years' experience with intraluminal US of the biliary ducts performed on 24 patients via a biliary transhepatic-duodenal drainage catheter or a surgically inserted T tube (2 cases). The final diagnosis was a malignant disease in 16 patients and a benign disease in 8 patients. We used an Intra Vascular Ultra Sound (Diasonics) unit with a 20 MHz transducer inserted into a 9 F catheter with closed tip, which in turn was pushed through the biliary ducts in a 12 F sheathed introducer which provides a safety metal guide wire in the duodenum. US examinations lasted only a few minutes and caused no additional patient discomfort; no complications followed. Intraluminal US confirmed the results of other clinical and instrumental tests in 18/24 patients and improved the diagnostic yield in assessing lesion nature and operability in 6 cases (25%). Its cost is high, but the Intra Vascular Ultra Sound includes a 3.5 MHz and a 7 MHz probes and can therefore be used for all the other US examinations needed in interventional radiology rooms and in the study of the biliary ducts. To decrease the cost, we used the Intra Vascular Ultra Sound in less than 10% of the patients treated for biliary obstruction in the same period of time, namely those with questionable diagnosis and operability. We conclude that intraluminal US of the biliary ducts is a useful tool in the centers using interventional radiology to treat many obstructive jaundice patients by a transhepatic approach.