Diagnostic Evaluation of the Bile Ducts
Diagnostic Advantages | Diagnostic Limitations |
---|---|
Hepatobiliary ultrasound | |
Rapid | Bowel gas |
Simultaneous scanning of GB, liver, bile ducts, pancreas | Massive obesity Ascites |
Accurate identification of dilated bile ducts | Barium |
Not limited by jaundice, pregnancy | Partial bile duct obstruction |
Guidance for fine-needle biopsy | Poor 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 ducts | Cannot offer therapeutic intervention |
Has excellent sensitivity for bile duct dilation, biliary stricture, and intraductal abnormalities | High cost |
Can identify pancreatic duct dilation or stricture, pancreatic duct stenosis, and pancreas divisum | |
Endoscopic retrograde cholangiopancreatography | |
Simultaneous pancreatography | Gastroduodenal 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 dilated | Nondilated 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.