1. Differential Diagnosis and Treatment of Biliary Strictures
Kazuo Inui, Junji Yoshino, Hironao Miyoshi 
Clinical Gastroenterology and Hepatology 
Volume 7, Issue 11, Pages S79-S83 (November 2009)
DOI: /j.cgh
Copyright © 2009 AGA Institute Terms and Conditions

2. Figure 1
(A) IDUS shows regular thickening of the bile duct wall in a patient with benign stricture. (B) IDUS shows irregular thickening (white arrows) of the bile duct wall in a patient with cholangiocarcinoma. (C) IDUS shows irregularity of the outer hyperechoic layer (white arrows) in a patient with cholangiocarcinoma invading to deep tissues.
Clinical Gastroenterology and Hepatology 2009 7, S79-S83DOI: ( /j.cgh )
Copyright © 2009 AGA Institute Terms and Conditions

3. Figure 2
IDUS showing marked echo attenuation in a patient with chronic pancreatitis. IDUS could not distinguish the bile duct wall from the pancreatic parenchyma.
Clinical Gastroenterology and Hepatology 2009 7, S79-S83DOI: ( /j.cgh )
Copyright © 2009 AGA Institute Terms and Conditions

4. Figure 3 Decision tree of biliary strictures with IDUS.
Clinical Gastroenterology and Hepatology 2009 7, S79-S83DOI: ( /j.cgh )
Copyright © 2009 AGA Institute Terms and Conditions

5. Figure 4
PTCS displayed tortuous vessels at the stenosis of the bile duct which we diagnosed as tumor vessels.
Clinical Gastroenterology and Hepatology 2009 7, S79-S83DOI: ( /j.cgh )
Copyright © 2009 AGA Institute Terms and Conditions

6. Figure 5
With (A) NBI, PTCS depicted the mucosa more clearly than (B) ordinary observation.
Clinical Gastroenterology and Hepatology 2009 7, S79-S83DOI: ( /j.cgh )
Copyright © 2009 AGA Institute Terms and Conditions

7. Figure 6
(A) A cholangiogram performed via PTBD of sinus tract depicted obstruction of the proximal extrahepatic bile duct. (B) A 16 F catheter was inserted into the stricture and kept inserted as a stent for 8 days. (C) The stenosis was improved after removal of the catheter.
Clinical Gastroenterology and Hepatology 2009 7, S79-S83DOI: ( /j.cgh )
Copyright © 2009 AGA Institute Terms and Conditions

8. Figure 7
(A) PTBD cholangiography indicated a regular stenosis of the distal common bile duct. (B) A 10 F catheter was passed along a guidewire to the duodenum, with subsequent gradual substitution of larger catheter up to 16 F. (C) PTBD cholangiography 6 months after dilation with a bougie confirmed dilation of the stricture.
Clinical Gastroenterology and Hepatology 2009 7, S79-S83DOI: ( /j.cgh )
Copyright © 2009 AGA Institute Terms and Conditions