Value of endoscopic ultrasonography in the detection of anomalous connections of the pancreatobiliary duct.

Endoscopic ultrasonography (EUS) was evaluated in the detection of anomalous connection of the pancreatobiliary duct (ACPBD), which is known to cause cholangitis and has been found to be associated with cholangiocarcinoma. Fourteen patients with ACPBD were examined preoperatively by EUS in addition to ERCP and/or PTC. In all cases, the anomalous connections between the biliary and pancreatic duct were demonstrated to be located outside the proper muscle of the duodenal wall and within the pancreatic parenchyma. EUS classification of ACPBD corresponded well with the findings obtained by retrograde ductal opacification on ERCP and PTC. Biliary malignancy complicating ACPBD was detected correctly by EUS in two patients. In contrast, no connections between biliary and pancreatic ducts were found by EUS in 13 normal controls. It is concluded that EUS is highly sensitive in detecting ductal anomaly in ACPBD. Further studies will show if EUS can replace ERCP in the diagnosis of ACPBD.