Elsevier

Gastrointestinal Endoscopy

Volume 45, Issue 2, February 1997, Pages 143-146
Gastrointestinal Endoscopy

Endoscopic ultrasonography for diagnosing choledocholithiasis: a prospective comparative study with ultrasonography and computed tomography,☆☆,

https://doi.org/10.1016/S0016-5107(97)70237-2Get rights and content

Abstract

Background: We assessed the diagnostic usefulness of endoscopic ultrasonography (EUS) for choledocholithiasis. Methods: A prospective series of 155 patients with suspected choledocholithiasis all underwent EUS, conventional ultrasonography, CT, and ERCP. In 142 patients with a clear cholangiogram on ERCP, we analyzed the capability of EUS to image the extrahepatic bile duct and to identify choledocholithiasis, compared with ultrasonography and CT. Results: No complications were encountered in performing EUS. In 51 patients, ERCP demonstrated bile duct stones, which were confirmed at endoscopic sphincterotomy or surgery. The extrahepatic bile duct was wholly displayed in 96% by EUS, in 60% by ultrasonography, and in 80% by CT. EUS (96%) was more sensitive than ultrasonography (63%) and CT (71%) for detecting choledocholithiasis (p < 0.001). Although ultrasonography and CT were poorly diagnostic for choledocholithiasis in patients with small stones or those with a nondilated common bile duct, EUS was able to accurately detect choledocholithiasis regardless of the size of stones or the diameter of the bile duct. The specificity of EUS (100%) was higher than those of ultrasonography (95%) and CT (97%). Conclusions: EUS, a safe imaging procedure, is more accurate than ultrasonography and CT and may be as accurate as ERCP for diagnosing choledocholithiasis. (Gastrointest Endosc 1997;45:143-6.)

Section snippets

PATIENTS AND METHODS

Between 1993 and 1995, we studied a prospective series of 155 consecutive patients (70 men and 85 women; age range, 21 to 91 years, mean, 61.2 years) who were referred for ERCP because of suspected choledocholithiasis. All patients met at least one of the following criteria for ERCP; epigastric or right upper quadrant pain with fever (75 patients), jaundice (81 patients), abnormal blood liver chemistry test (102 patients), a dilated common bile duct (>7 mm in diameter) on conventional

RESULTS

No complications were encountered after EUS in 37 patients who underwent EUS and ERCP on separate days. However, 3 of 118 patients who underwent both EUS and ERCP on the same day had minor complications: mild acute pancreatitis (2 patients) and acute cholangitis (1 patient). These complications were attributed to ERCP.

In 142 of 155 patients, ERCP clearly depicted the entire extrahepatic bile duct. Of 142 patients, 51 had common bile duct stones demonstrated by ERCP, which were subsequently

DISCUSSION

The present prospective study showed that EUS depicted the whole length of the extrahepatic bile duct in 96% of the patients and that EUS detected common bile duct stones in 96% of the patients.

The sensitivity (63%) of ultrasonography for choledocholithiasis in our series was comparable to that previously reported (55% to 75%3, 4, 5, 6). The low sensitivity of ultrasonography is partly due to abdominal fat or overlying bowel gas obscuring images of the common bile duct, especially of the distal

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Cited by (0)

From the First Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan.

☆☆

Reprint requests: Masanori Sugiyama, MD, First Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181, Japan.

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