Background Dilated CBD on non-invasive imaging with normal or borderline derangement of LFT and unremarkable physical signs has always been a diagnostic dilemma. In the clinical setting, however, determining the presence of ductal calculi remains a significant dilemma; a balance must be struck between invasive ERCP, associated complications, and potentially inaccurate diagnosis. Hence, we prefer EUS as the preferred investigation prior to ERCP during the same sedation, regardless of the results of previous imaging studies. Hence, we evaluated all patients with EUS who were referred to our center for ERCP for suspected choledocholithiasis. Each patient had at least 1 additional modality of imaging other than the US Abdomen with a cholestatic liver function test.

The use of EUS in such cases may help reach the diagnosis and avoid unnecessary ERCP.

Aim To see the diagnostic yield of EUS prior to ERCP for patients with dilated CBD and other inconclusive imaging studies with normal or borderline derangement of LFT.

Methods A retrospective analysis of 900 patients, referred for ERCP in last 6 years with inconclusive imaging study for dilated CBD and normal to borderline LFT derangement. The diagnostic yield of EUS prior to ERCP was measured. The feasibility and outcome of combined EUS-ERCP were recorded.

Results EUS was able to diagnose the cause of CBD dilatation in all cases- Diagnostic yield-100%. 600 patients (66.67%) underwent ERCP procedure and 300 patients (33.33%) had avoided unnecessary ERCP (IDDF2024-ABS-0003 Table 1).

Conclusions EUS has remarkable diagnostic yield for the etiology of dilated CBD with inconclusive Ultrasound, CT scan, or MRCP.

Combined EUS-ERCP is feasible, cost-effective, and highly accurate and thus can avoid unnecessary ERCPs.