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Table 150-1

Diagnostic Evaluation of the Bile Ducts

Diagnostic AdvantagesDiagnostic Limitations
Hepatobiliary ultrasound
RapidBowel gas
Simultaneous scanning of GB, liver, bile ducts, pancreas

Massive obesity

Ascites

Accurate identification of dilated bile ductsBarium
Not limited by jaundice, pregnancyPartial bile duct obstruction
Guidance for fine-needle biopsyPoor visualization of distal CBD
Computed tomography
Simultaneous scanning of GB, liver, bile ducts, pancreas

Extreme cachexia

Movement artifact

Accurate identification of dilated bile ducts, masses

Ileus

Partial bile duct obstruction

Not limited by jaundice, gas, obesity, ascites
High-resolution image
Guidance for fine-needle biopsy
Magnetic resonance cholangiopancreatography
Useful modality for visualizing pancreatic and biliary ductsCannot offer therapeutic intervention
Has excellent sensitivity for bile duct dilation, biliary stricture, and intraductal abnormalitiesHigh cost
Can identify pancreatic duct dilation or stricture, pancreatic duct stenosis, and pancreas divisum
Endoscopic retrograde cholangiopancreatography
Simultaneous pancreatographyGastroduodenal obstruction
Best visualization of distal biliary tract?Roux-en-Y biliary-enteric anastomosis
Bile or pancreatic cytology
Endoscopic sphincterotomy and stone removal
Biliary manometry
Percutaneous transhepatic cholangiogram
Extremely successful when bile ducts dilatedNondilated or sclerosed ducts
Best visualization of proximal biliary tract
Bile cytology/culture
Percutaneous transhepatic drainage
Endoscopic ultrasound
Most sensitive method to detect ampullary stones

Abbreviations: CBD, common bile duct; GB, gallbladder.