Diagnostic Evaluation of the Bile Ducts | ||||
| DIAGNOSTIC ADVANTAGES | DIAGNOSTIC LIMITATIONS | CONTRAINDICATIONS | COMPLICATIONS | COMMENT |
|---|---|---|---|---|
| Hepatobiliary ultrasound | ||||
Rapid Simultaneous scanning of GB, liver, bile ducts, pancreas Accurate identification of dilated bile ducts Not limited by jaundice, pregnancy Guidance for fine-needle biopsy | Bowel gas Massive obesity Ascites Barium Partial bile duct obstruction Poor visualization of distal CBD | None | None | Initial procedure of choice in investigating possible biliary tract obstruction |
| Computed tomography | ||||
Simultaneous scanning of GB, liver, bile ducts, pancreas Accurate identification of dilated bile ducts, masses Not limited by jaundice, gas, obesity, ascites High-resolution image Guidance for fine-needle biopsy | Extreme cachexia Movement artifact Ileus Partial bile duct obstruction | Pregnancy | Reaction to iodinated contrast, if used | Indicated for evaluation of hepatic or pancreatic masses Procedure of choice in investigating possible biliary obstruction if diagnostic limitations prevent HBUS |
| Magnetic resonance cholangiopancreatography | ||||
Useful modality for visualizing pancreatic and biliary ducts Has excellent sensitivity for bile duct dilatation, biliary stricture, and intraductal abnormalities Can identify pancreatic duct dilatation or stricture, pancreatic duct stenosis, and pancreas divisum | Cannot offer therapeutic intervention High cost | Claustrophobia Certain metals (iron) | None | |
| Endoscopic retrograde cholangiopancreatography | ||||
Simultaneous pancreatography Best visualization of distal biliary tract Bile or pancreatic cytology Endoscopic sphincterotomy and stone removal Biliary manometry | Gastroduodenal obstruction Roux-en-Ybiliary-entericanastomosis | Pregnancy Acute pancreatitis Severe cardiopulmonary disease | Pancreatitis Cholangitis, sepsis Infected pancreatic pseudocyst Perforation (rare) Hypoxemia, aspiration | Cholangiogram of choice in: Absence of dilated ducts Pancreatic, ampullary or gastroduodenal disease Prior biliary surgery Endoscopic sphincterotomy treatment possibility |
| Percutaneous transhepatic cholangiogram | ||||
Extremely successful when bile ducts dilated Best visualization of proximal biliary tract Bile cytology/culture Percutaneous transhepatic drainage | Nondilated or sclerosed ducts | Pregnancy Uncorrectable coagulopathy Massive ascites Hepatic abscess | Bleeding Hemobilia Bile peritonitis Bacteremia, sepsis | Indicated when ERCP is contraindicated or failed |
| Endoscopic ultrasound | ||||
| Most sensitive method to detect ampullary stones | Excellent for detecting choledocholithiasis | |||