Diagnostic value of biliopancreatic endosonography in the diagnosis of acute cholangitis secondary to biliary obstruction

Abstract

Background and Objectives:The diagnosis of obstructive cholangiopathies by biliopancreatic endosonography has been extensively studied, and there is an extensive recognition of its role in the diagnosis of choledocholithiasis, biliopancreatic tumors, and extrinsic biliary compression syndromes. Cholangitis, a more frequent complication of biliary obstruction, which is responsible for much of its morbidity and mortality, has not been sufficiently linked to endosonographic findings.Methods:Our study attempted to define the diagnostic validity of endosonography in patients with acute cholangitis to limit the morbidity and mortality of the diagnostic delay and simultaneously achieve an etiological diagnosis and a primary management plan in patients at risk. A descriptive study was carried out to analyze the clinical histories of patients undergoing biliopancreatic endosonography for obstructive jaundice of any etiology and who were subsequently taken to endoscopic retrograde cholangiopancreatography (ERCP) to manage biliary obstruction, for which we compared the endosonographic findings compatible with acute cholangitis (thickening of the bile duct of 1.5 mm or more, presence of pericolangitic halo of at least 1.5 cm in length, and presence of mixed echogenicity content in the interior of the pathway biliar) with the presence of purulent drainage in ERCP.Results:A high frequency of these findings was found in patients with cholangitis, with biliary wall thickening being more common in 92.6% of cases. Moreover, to a lesser extent, the pericholangitic halo presence in 59.3% and ductal content in 66.7% of the cases. No differences were found in the demographic characteristics of patients such as age and sex. The etiology of biliary obstruction showed a behavior similar to that of historical controls.Conclusions:It is advisable to carry out studies with a greater statistical power, to validate our results, for a future inclusion of EUS in the diagnostic algorithm of clinical practice guidelines in acute cholangitis.