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Endoscopy 2006; 38: 23-29
DOI: 10.1055/s-2006-946647
Invited papers
Pancreatitis and cholelithiasis
© Georg Thieme Verlag KG Stuttgart · New York

Choledocholithiasis - a practical approach from the endosonographer

D. O’Toole1 , L. Palazzo1
  • 1Service de Gatroentérologie, Hôpital Beaujon, Clichy 92118, Beaujon Hospital, University of Paris VII, Clichy, France
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Publication History

Publication Date:
26 June 2006 (online)

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Introduction

The widespread availability of endoscopic ultrasound (EUS) has facilitated evaluation of the pancreas and extra-hepatic biliary system. EUS to date has been shown to be highly sensitive in the detection of both choledocholithiasis (especially in patients with small stones and non-dilated bile ducts) and gallbladder microlithiasis, however the use of this technique in relation to endoscopic retrograde cholangiography (ERCP) and laparoscopic surgery in gallstone disease remains somewhat confusing. EUS has the added advantage of accurately discriminating CBD obstruction due to choledocholithiasis and other causes such as small ampullary tumours, cholangiocarcinoma, benign extra-heaptic cholangitis, congenital bile duct or peri-ampullary abnormalities (which together account for 10 - 20 % of cases of CBD obstruction in patients with suspicion of CBD stones). This review highlights technical aspects of examining the extra-hepatic biliary duct system and the clinical performance and results of EUS in this context and proposes strategies in relation to its use in association with ERCP and surgery in common clinical practice. The use of EUS in patients with a asymptomatic dilated common bile duct (CBD) is also discussed.

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Laurent Palazzo (MD)

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Phone: 0033 1 47 42 15 51

Email: laurent.palazzo@wanadoo.fr

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