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.