Trans-nasal biliary drainage tube water-injection ultrasound:a new method for detecting residual stones after endoscopic extraction of bile duct stones
Objective To observe the ability of abdominal ultrasonography(hereinafter referred to as water-injection ultrasonography)after injection of 0.9％sodium chloride solution via endoscopic nasobiliary drainage tube in the detection of residual stones in bile duct after stone extraction by endoscopic retrograde cholangiopancreatography(ERCP).Methods From January 2015 to June 2023,at the Second Department of General Surgery,Shengjing Hospital,China Medical University,342 patients,who were diagnosed with choledochal stones and received stone extraction by ERCP and at the same time placed endoscopic nasobiliary drainage tube,were enrolled.After stone extraction by ERCP,all the patients underwent cholangiography,conventional abdominal ultrasound,and water-injection ultrasonography.The patients with stones removed by the secondary ERCP were positive.The ability to detect residual stones in bile duct by cholangiography,conventional abdominal ultrasound and water-injection ultrasonography were compared.Chi-square test was performed for statistical analysis.Results The results of cholangiography showed that 35 patients were suspected with residual stones in bile duct,among them 28 were confirmed to be true-positive,the sensitivity was 50.9％and specificity was 97.6％;the results of conventional abdominal ultrasound showed that 15 patients were suspected with residual stones in bile duct,among them 13 were confirmed to be true positive with a sensitivity of 23.6％and a specificity of 99.3％;and the results of water-injection ultrasonography showed that 56 patients were suspected with residual stones in bile duct,among them 50 were confirmed as true positive,with a sensitivity of 90.9％and a specificity of 97.9％.The number of true-positive patients detected by water-injection ultrasonography was greater than those determined by cholangiography and conventional abdominal ultrasonography,and the sensitivity was higher than that of cholangiography and conventional abdominal ultrasonography,and the differences were statistically significant(x2=21.33,50.85,38.77 and 92.53,all P＜0.001).There was no statistically significant difference in the specificity among water-injection ultrasonography,cholangiography and conventional abdominal ultrasonography(both P＞0.05).Conclusion Water-injection ultrasonography can effectively improve the detection rate of residual stones in bile duct after ERCP.
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