Endoscopy 2006; 38(7): 717-722
DOI: 10.1055/s-2006-944524
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Intraductal ultrasonography in the diagnosis of Mirizzi syndrome

T.  Wehrmann1 , A.  Riphaus1 , K.  Martchenko1 , S.  Kokabpick1 , H.  Pauka1 , N.  Stergiou1 , M.  B.  Frenz1
  • 1Medizinische Klinik I, Klinikum Hannover-Siloah, Hannover, Germany
Further Information

Publication History

Submitted 21 September 2005

Accepted after revision 3 April 2006

Publication Date:
29 June 2006 (online)

Background and study aims: Common bile duct (CBD) compression can be caused by stones in the cystic duct (Mirizzi syndrome) which can be difficult to diagnose even with endoscopic retrograde cholangiopancreatography (ERCP). Conventional imaging often gives insufficient information and endoscopic ultrasonography (EUS) and magnetic resonance imaging may improve diagnostic accuracy, but often the final diagnosis is made during exploratory surgery.
Patients and methods: All patients undergoing ERCP during a 3-year period were prospectively analyzed if they fulfilled the inclusion criteria: gallbladder in situ; obstructive jaundice with CBD stenosis, demonstrated at endoscopic retrograde cholangiography (ERC), but unexplained at ultrasonography; and inability to demonstrate the cystic duct during ERC. Intraductal ultrasonography (IDUS) was carried out over a guide wire using a 20-MHz probe. Prior to ERCP, patients were evaluated with abdominal ultrasonography and computed tomography (CT), as well as by magnetic resonance cholangiopancreatography (MRCP) or EUS in some.
Results: 74 patients out of 2089 undergoing ERCP fulfilled the entry criteria. Final diagnoses, from surgical exploration (n = 41), cytology (n = 21), or endoscopic extraction of stones from the cystic duct (n = 12), were Mirizzi syndrome (type I) in 30 patients and other causes in 44 patients (gallbladder carcinoma [n = 16], pancreatic carcinoma [n = 9], metastatic compression [n = 9], other [n = 10]). CT had shown suspected Mirizzi syndrome in 1/30 cases (3 %) and MRCP in 12/19 evaluated cases (63 %). EUS allowed a correct diagnosis in 11 of 15 evaluated cases (73 %). IDUS required an additional 8 ± 3 min and showed a sensitivity of 97 % and specificity of 100 %.
Conclusion: IDUS is a sensitive and specific method for the diagnosis of Mirizzi syndrome.

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M. B. Frenz, M. D.

Department of Internal Medicine

Academic Hospital Hannover-Siloah · Roesebeckstraße 15 · 30449 Hannover · Germany

Fax: +49-511-9272669

Email: mfrenz@doctors.org.uk