Abstract
BackgroundLess than 67% of patients with intermediate risk for common bile duct (CBD) stones require therapeutic intervention. It is important to have an accurate, safe, and reliable method for the definitive diagnosis of CBD stones before initiating therapeutic endoscopic retrograde cholangiopancreatography (ERCP). Few publications detail the diagnostic efficacy of linear echoendoscopy (EUS) for CBD stones.Methods30 patients with biliary colic, pancreatitis, unexplained derangement of liver function tests, and/or dilated CBD without an identifiable cause were enrolled in the study. When a CBD stone was disclosed by linear EUS, ERCP with stone extraction was performed. Patients who failed ERCP were referred for surgical intervention. If no stone was found by EUS, ERCP would not be performed and patients were followed-up for possible biliary symptoms for up to three months.ResultsThe major reason for enrollment was acute pancreatitis. The mean predicted risk for CBD stones was 47% (28–61). Of the 12 patients who were positive for CBD stones by EUS, nine had successful ERCP, one failed ERCP (later treated successfully by surgical intervention) and two were false-positive cases. No procedure-related adverse events were noted. For those 18 patients without evidence of CBD stones by EUS, no false-negative case was noted during the three-month follow-up period. Linear EUS had sensitivity, specificity, positive and negative predicted values for the detection of CBD stones of 1, 0.9, 0.8 and 1, respectively.ConclusionLinear EUS is safe and efficacious for the diagnosis of occult CBD stones in patients with intermediate risk for the disease.
Highlights
No direct evidence of common bile duct (CBD) stones was found by means of transabdominal ultrasound (30 patients) and computed tomography (CT) scan (24 patients, others did not receive CT scan exam)
Of the 12 patients who were positive for CBD stones by EUS (Figure 2), eight were treated successfully using endoscopic retrograde cholangiopancreatography (ERCP) in the same section
Magnetic resonance cholangiopancreatography (MRCP) is especially useful for potentially occult CBD stones that fail to be discovered by conventional ultrasound or CT scans, as in our cases
Summary
Less than 67% of patients with intermediate risk for common bile duct (CBD) stones require therapeutic intervention. It is important to have an accurate, safe, and reliable method for the definitive diagnosis of CBD stones before initiating therapeutic endoscopic retrograde cholangiopancreatography (ERCP). Endoscopic retrograde cholangiopancreatography (ERCP) remains the gold standard for both diagnosis and treatment of CBD stones; the procedure is associated with an overall complication rate of 5–10% and mortality rate of 0.02–0.5% [4,5,6,7]. It has been shown that the rate of post-ERCP pancreatitis may be as high as 15%, which includes 1% of patients graded as severe in degree [8] This is true in high risk patients such as suspected sphincter of Oddi dysfunction, but not bile duct stones. Safe, and efficacious method is needed to diagnose CBD stones in a definitive manner
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call