Good for biliary dilatation – may identify level of obstruction of extrahepatic bile duct. Sensitive for stones and some tumors. Less useful at hilum and beyond…Useful for inspecting the gallbladder for stones and masses…
Excellent views of the biliary tree from the hilum down, the gallbladder, the entire pancreas, the celiac plexus. Offers tissue acquisition for cytopathology through EUS-fine needle aspiration (FNA). Therapeutic potential includes direct bile duct and pancreatic puncture.
Helpful if endoscopic access problematic. May provide optimal bilateral access for drainage and stenting. PTC placed catheters uncomfortable for patient (drains) and prone to leakage and displacement. Risks include bleeding, bile leak. Tough access ducts if not dilated.
IDUS may elucidate nature of a stricture (e.g. in PSC). Choledochoscopy used to be regarded as experimental, but has become widely available through SpyGlass™ technology. May be helpful in the characterization of strictures and to look for bile duct stones.