Journal of Ultrasound in Medicine, Vol 20, Issue 1 15-19, Copyright © 2001 by American Institute of Ultrasound in Medicine
Laparoscopic ultrasonographic appearance of the common bile duct mucosa: a predictor of choledocholithiasis
E. Berber, A. M. Garland, A. Foroutani, A. String and A. E. Siperstein
Department of General Surgery, The Cleveland Clinic Foundation, Ohio 44195, USA.
Previously we reported on the use of laparoscopic ultrasonography in
detecting common bile duct stones during laparoscopic cholecystectomy. The
aim of this study is to describe the laparoscopic ultrasonographic
appearance of the common bile duct mucosa in patients with
choledocholithiasis. Medical records of 44 patients with an increased risk
for common bile duct stones undergoing laparoscopic cholecystectomy between
1993 and 1998 were reviewed. In the operating room, the laparoscopic
ultrasonographic appearance of the common bile duct mucosa was scored in
real time as normal, mild changes (hyperechoic mucosa), or severe changes
(hyperechoic with mucosal thickening). Of the 31 patients (70%) with stones
or sludge in the biliary tree, 29 (94%) had either severe (58%) or mild
(36%) hyperechoic and 2 (6%) had normal-appearing common bile duct mucosa
on laparoscopic ultrasonography. Of the 13 patients (30%) with no
documented stones or sludge, 11 (85%) had normal and 2 (15%) had mild
hyperechoic common bile duct mucosa on laparoscopic ultrasonography. Both
of these patients had laboratory values indicating recent passage of common
bile duct stones. The association between common bile duct stones and the
presence of hyperechoic common bile duct mucosa was statistically
significant (P < .0001, Fisher's exact test). This is the first report
of hyperechoic common bile duct mucosa demonstrated by laparoscopic
ultrasonography as a predictor of common bile duct stones. This finding is
evident in the majority of patients with common bile duct stones and also
may be associated with recent passage of a stone into the duodenum.
