Le hile est-il devenu accessible à l’échoendoscopie?
Has the hilum become accessible to echoendoscopy?
When ultrasonography discovers (he diagnosis of a hilar obstacle, MRI is currently the secondline of investigation. This is despite the fact that it has diagnostic limitations regarding the nature and staging of the cholangiocarcinomas. Although the new generation of échoendoscopic equipment offers an increasing depth of scanning, the hepatic hilum remains to be imperfectly investigated using conventional echoendoscopy. The presence of an enlargement of the intrahepatic biliary channel is, in the absence of a dilated common bile duct, the main clue for a hilar obstacle. Two techniques can provide complementary information: puncture under echoendoscopy guidance can prove the malignant nature of the lesion or of remote lymph nodes; intracholedocal investigation using a miniprobe is helpful in diagnosing the nature of the stenosis and can determine, in a more efficient manner than other investigations, the pretherapeutic staging. These procedures remain semiinvasive, and this procedure of complementary evaluation should only be considered as a thirdline option and only if therapeutic impact is expected.
cholangiocarcinoma, endosonography, hepatic hilum, intraductal mini-probe