Abstract

RICARDO R, Andrés Mauricio  and  ARANGO M, Lázaro Antonio. Diagnostic Validity of Biliopancreatic Endosonography in the Diagnosis of Acute Cholangitis Secondary to Biliary Obstruction. Rev Col Gastroenterol [online]. 2017, vol.32, n.3, pp.216-222. ISSN 0120-9957.  https://doi.org/10.22516/25007440.153.

Diagnosis of obstructive cholangiopathy with biliopancreatic endosonography (BUS) has been extensively studied, and its role in the diagnosis of choledocholithiasis, biliopancreatic junction tumors and extrinsic biliary compression syndromes is widely recognized. Endosonographic diagnosis of cholangitis, a more frequent complication of biliary obstruction which is responsible for much of its morbidity and mortality, has not been sufficiently studied.

Our study’s objective is to define the diagnostic validity of endosonography for patients with acute cholangitis in order to limit morbidity and mortality due to diagnostic delay.

This is a descriptive study that analyzes clinical histories of patients who underwent biliopancreatic endosonography because of obstructive jaundice of any etiology and who later underwent endoscopic retrograde cholangiopancreatography (ERCP) to manage biliary obstruction. We compared endosonographic findings compatible with acute cholangitis: thickening of the bile duct of 1.5 mm or more, periportal halo sign of at least 1.5 cm in length, mixed echogenicity of bile duct content, and purulent drainage during ERCP.

Patients with cholangitis most frequently presented thickened gallbladders (92.6% of cases) periportal halo signs (59.3% of cases) and mixed echogenicity of bile duct content (66.7% of cases). We also found an ascending association of frequencies with the degree of severity of cholangitis.

Studies with greater statistical power are needed for validation of our results and for future inclusion of EUS in the diagnostic algorithm for clinical practice guidelines in cases of acute cholangitis.

Keywords : Endoscopic endosonography; cholangitis; diagnostic imaging of cholangitis; obstructive cholangiopathy; biliary obstruction; biliary infection.

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