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PTH-079 Direct-to-test endoscopic ultrasound
  1. P Lochhead,
  2. P S Phull
  1. Gastrointestinal and Liver Service, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK

Abstract

Introduction Endoscopic ultrasound (EUS) has become an invaluable investigation in the assessment of pancreatobiliary disease. EUS is superior to abdominal ultrasound in pancreatobiliary imaging having a sensitivity of >90% for choledocholithiasis and affording better views of the pancreas. Traditionally, patients tend to undergo EUS following specialist review. We are not aware of any reports of direct-to-test EUS for patients who have been assessed only by a general practitioner (GP). We propose that, in selected patients with suspected choledocholithiasis, direct-to-test EUS is safe and avoids specialist clinic review and the attendant delay, expense and inconvenience. Here we present our initial data on direct-to-test EUS in a teaching hospital setting.

Methods Twenty-four patients who had been referred to the gastroenterology department at our institution by their general practitioners between February 2005 and July 2009 were selected to be offered direct-to-test EUS. Selected patients had liver chemistry and/or symptomatology compatible with biliary pathology; all but one patient had had an abdominal ultrasound scan before referral. A patient information leaflet was sent in the post along with the appointment letter.

Results All patients accepted direct-to-test EUS appointment; the average time from referral to procedure was 6 weeks. The average patient age was 59 years (range 21–83); 17 out of 24 patients were female (71%). The clinical details were: biliary-type pain with abnormal liver chemistry but normal ducts on ultrasound (n=14); abnormal liver chemistry with duct dilatation but no stones identified on ultrasound (n=4); biliary-type pain, normal chemistry, with duct dilatation but no stones on ultrasound (n=3); progressive cholestatic liver chemistry post cholecystectomy with no duct dilatation on ultrasound (n=2); unexplained recent pancreatitis with a normal ultrasound (n=1). The EUS findings for the 24 patients were: normal examination (n=13), choledocholithiasis (n=3), gallstones (n=5), hepatic steatosis (n=2), periampullary tumour (n=1). Three of the cases of gallstones had not been previously identified on abdominal ultrasound scanning. The overall yield for pathology was 46%. There were no noted complications in any of the 24 cases. On the basis of the EUS examination, three patients were referred for ERCP, two for cholecystectomy, and one for a Whipple's procedure. This equates to a 25% onward referral rate for definitive treatment based on the direct-to-test EUS findings.

Conclusion Our initial data support the hypothesis that direct-to-test EUS for selected patients with suspected biliary disease is a safe investigation, with a high yield of significant pathology.

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