Endoscopic Ultrasonography In Patients Research Articles

Incidental detection of upper gastrointestinal epithelial neoplasia by screening endoscopy prior to endoscopic ultrasonography in patients with pancreaticobiliary disease

BackgroundScreening esophagogastroduodenoscopy plays an important role in the early detection of upper gastrointestinal cancer. To provide more opportunities for patients with pancreaticobiliary disease to undergo this screening, we have performed esophagogastroduodenoscopy prior to endoscopic ultrasonography. However, the usefulness of this protocol is not elucidated. This study aimed to investigate the utility of screening esophagogastroduodenoscopy in this protocol in the detection of upper gastrointestinal epithelial neoplasms.MethodsThe outcomes of screening esophagogastroduodenoscopy performed prior to endoscopic ultrasonography in patients with pancreaticobiliary disease at our hospital between April 2020 and September 2022 were investigated. A logistic regression model was used to identify factors affecting the detection of epithelial neoplasms. Additionally, we compared the detection rate of gastric epithelial neoplasms between screening esophagogastroduodenoscopy performed prior to endoscopic ultrasonography and that performed at our medical checkup center.ResultsA total of 615 screening esophagogastroduodenoscopies prior to endoscopic ultrasonography were performed, and 12 (2.0%) epithelial neoplasms were detected, including esophageal lesions (n = 2) and gastric lesions (n = 10). Of these lesions, 75% (9/12) underwent curative endoscopic resection. A multivariate analysis showed that open-type gastric mucosal atrophy (odds ratio, 7.7; 95% confidence interval, 1.5–38.4; p = 0.01) and the use of magnification endoscopy (odds ratio, 7.3; 95% confidence interval, 1.9–27.9; p < 0.01) independently affected the detection of epithelial neoplasms. The detection rate of gastric epithelial neoplasms was significantly higher using this protocol than that in our medical checkup center (1.6% versus 0.2%, p < 0.01).ConclusionsA protocol of screening esophagogastroduodenoscopy prior to endoscopic ultrasonography may be recommended because epithelial neoplasms could be detected at a non-negligible rate.

Diagnostic sensitivity of endoscopic ultrasonography in patients with suspected choledocholithiasis

The likelihood of common bile duct stones can be prognosticated by various clinical predictors, however, the sensitivity and specificity of these factors are moderate. Endoscopic ultrasonography has been shown to be a semi-invasive precise test for the detection of common bile duct stones. Our aim was to assess the diagnostic accuracy of endoscopic ultrasonography in patients with suspected choledocholithiasis. Patients of this prospective study were categorized and divided into intermediate likelihood and high likelihood groups according to the clinical predictors defined by the American Society of Gastrointestinal Endoscopy (ASGE) guidelines and referred for linear endosonography. Endoscopic retrograde cholangiopancreatography (ERCP) was performed if needed. A total of 95 patients were assessed. Common bile duct stones were detected by endoscopic ultrasonography overall in 53 (56%) patients: 55% (39/71) in the intermediate likelihood and 58% (14/24) in the high likelihood group of patients. The detected common bile duct stones in all patients were confirmed by ERCP. There was no significant difference (p = 0.56) in the detection of stones by ERCP between the two likelihood groups. ERCP confirmed choledocholithiasis only in one patient whose preceding endosonography did not detect stone. The specificity and sensitivity of endoscopic ultrasonography were 100% and 98%, the positive predictive value and negative predictive value were 100% and 98%, respectively. Estimating the likelihood of choledocholithiasis based on various clinical predictors might be challenging. Endoscopic ultrasonography is a highly sensitive and accurate diagnostic tool for the detection and evaluation of common bile duct stones also in patients with previous normal imaging findings. Orv Hetil. 2022; 163(10): 400-406.

Interventional endoscopic ultrasonography in patients with surgically altered anatomy: Techniques and literature review.

There are various reconstruction techniques that are used after upper gastrointestinal surgery. In recent years, opportunities for endoscopic diagnosis and treatment have been increasing in patients undergoing gastrointestinal surgery. With the advent of interventional endoscopic ultrasound (IV-EUS), various procedures have been developed mainly for patients in whom endoscopic retrograde cholangiopancreatography is difficult to carry out. Indications for such procedures are expanding. IV-EUS for surgically altered anatomy (SAA) includes EUS-guided fine-needle aspiration, biliary interventions (e.g. biliary drainage, treatment of bile duct stricture, removal of bile duct stones, and the rendezvous technique), and pancreatic interventions (e.g. rendezvous technique after Whipple surgery). In addition, there have been reports of various EUS-related procedures using a forward-viewing curved linear-array echoendoscope that are carried out for postoperative intestinal tract reconstruction. Although interventional EUS is a useful therapeutic procedure for SAA, there are still no dedicated devices, and standardization of the procedure is warranted.

Diagnostic value of endoscopic ultrasonography in patients with biliary-pancreatic duct dilatation

Objective To study the diagnostic value of endoscopic ultrasonography (EUS) in patients with cholangiopancreatic duct dilatation (CPDD). Methods Forty-five patients with CPDD and without any visual or detected obstructive lesions after traditional ultrasonography (US) were re-examined by EUS, CT and MRI. The diagnostic rates of EUS and the other imaging technologies were compared. Results All the 45 patients underwent successful EUS examination. Among them, there were 18 patients with periampullary tumor, 10 patients with lower common bile duct stones, 1 patient with pancreatic duct stones, 3 patients with chronic pancreatitis, 1 patient with an intrapancreatic choledochal cyst, 4 patients with inflammatory strictures of papilla of duodenum and 2 patients with terminal bile duct inflammatory stenosis. However, 1 patient with a lower common bile duct tumor, 1 patient with a small pancreatic head carcinoma and 1 patient with sphincter of Oddi dysfunction (SOD) were not diagnosed. The diagnostic rates of obstructive lesions by US, EUS, CT and MRI were 7.1%, 92.9%, 33.3%, 31.0%, respectively. The diagnostic rates of tumor were 10.0%, 90.0%, 35.0%, 25.0%, respectively. As compared with the other examination methods, EUS was best in detecting small carcinoma. Conclusion EUS plays an important role in the diagnosis of lesions causing cholangiopancreatic duct dilatation. Key words: Ultrasonography; Bile duct diseases; Pancreatic ducts; Endoscopic ultrasonography; Diagnosis

Clinical Impact of the Endoscopic Ultrasound in Patients With Intermediate Probability of Choledocholithiasis: Prospective and Comparative Study of 2 Treatment Strategies

Introduction: Due to the complications with ERCP (5-10%), its indication in patients with intermediate pre-test of choledocholithiasis (CL) should be backed up by less invasive and more sensitive methods such as the EUS. In several published studies, the EUS showed to be very effective at avoiding the performance of ERCP (30-73.3%) in patients with intermediate risk of CL. This is the first study made in Argentina that assesses the clinical impact that the EUS has as a “filtering” method to avoid unnecessary ERCPs. Objective: to determine the clinical impact of the EUS in the treatment of patients with intermediate probability of CL and the amount of ERCPs that could be avoided. Methods: Prospective study of patients with intermediate risk of CL (according to the ASGE criteria) in which two strategies are compared: a) Group with EUS: EUS was performed as a filter. ERCP was performed immediately in the cases in which CL is detected, while in the negative cases there was a clinical control; b) Group without EUS: ERCP was performed directly. The group was selected according to the availability of the physician performing the study. We consecutively included patients derived to our hospital to perform ERCP with suspicion of CL from January 2016 to April 2017. Results: 44 patients were included in the EUS group (average age: 37, 37 females) and 27 in the group without EUS (average age: 38, 21 females). In the first group, the results were negative for CL in 29 cases (66%); CL was detected in 15 patients (34%) to whom we performed ERCP and confirmed the diagnosis in 12 of them (80%). There was only one complication: post-ERCP low-grade pancreatitis. In the second group, the one without EUS, the ERCP was normal in 15 patients (56%), we found presence of CL in 10 cases (37%), biliary stenosis in 1 patient (3.7%) and cannulation failure in 1 case (self-limited hemorrhage after the infundibulotomy). There was one case of post-ERCP moderate pancreatitis. Conclusion: The EUS has shown to be very useful as a “filtering” method in the diagnostic algorithm of patients with intermediate risk of CL. In the EUS group, ERCP could be avoided in 2/3 of the patients, reducing the number of normal ERCPs and the risk of complications. We recommend the indication of EUS in the group of patients with intermediate suspicion of CL as previous instance for the performance of the ERCP.

115 Improved Diagnosis of Liver Metastases Using Kupffer-Phase Image of Contrast-Enhanced Harmonic Endoscopic Ultrasonography in Patients With Pancreatic Cancer

115 Improved Diagnosis of Liver Metastases Using Kupffer-Phase Image of Contrast-Enhanced Harmonic Endoscopic Ultrasonography in Patients With Pancreatic Cancer

Impact of Preoperative Endoscopic Ultrasound in Patients Undergoing Surgery for Non-cystic Lesions of the Pancreas

Introduction: Endoscopic ultrasound (EUS) is a standard modality in characterization of pancreatic lesions, especially in those patients who may undergo surgical resection. Our aims were to evaluate the impact and accuracy of preoperative EUS in patients who underwent surgical resection of non-cystic lesions of the pancreas. Methods: This was a single center retrospective study. Using CPT codes, patients with pancreatic lesions were identified over a 4 year period. ICD-9 codes were further utilized to determine which patients underwent EUS, surgery or both. Data analyzed included patient's clinical history, imaging and laboratory analysis. Results: The presence of any pancreatic diagnosis was identified in 6096 patients, of which 916 patients had only EUS and no surgical intervention. On the contrary, 174 patients had surgical intervention without preoperative EUS. 297 patients had palliative care consults for advanced malignancy with no further invasive work-up. Finally, 4923 patients had neither EUS nor surgical intervention. 96 patients that had both preoperative EUS followed by surgical resection were identified. Of these 96 patients, final surgical pathological diagnoses revealed 63 non-cystic lesions. Preoperative EUS diagnoses were correlated with final surgical pathology to determine concordance. Patient demographics, time from EUS to surgery, lesion size, number of FNA passes, and Ca19-9 levels were not statistically different between the groups (Table 1). Preoperative endoscopic work-up including EUS was accurate in 48/63 (76%) patients. The accuracy was improved to 53/63 (84%) patients when suspicious or atypical cytology was considered as a positive result. The most common diagnoses were adenocarcinoma 42/63 (67%), neuroendocrine tumors 9/63 (14%), and autoimmune pancreatitis 4/63 (6%). The accuracy for adenocarcinoma was 37/42 (88%) and for neuroendocrine tumors was 6/9 (67%). In the autoimmune group, malignancy was ruled out in 4/4(100%)(Table 2). In 11/63 (17%) patients in whom initial EUS-FNA was nondiagnostic, a repeat EUS-FNA resulted in a positive diagnosis in 7/11 (64%) patients. However in 4/11 (36%) patients repeat EUS-FNA remained nondiagnostic. Finally in 15/63 (24%) patients, preoperative EUS and final surgical pathology was discordant.Table 1: Demographics; EUS and surgical pathologyTable 2: Pathology dataConclusion: Based upon our data, EUS has an acceptable preoperative accuracy for non-cystic lesions in patients undergoing surgical resection. The most commonly identified pathology was adenocarcinoma for which endoscopic accuracy was 88%. Improvements in non-invasive imaging, identification of novel biomarkers, and refinements in EUS imaging, tissue acquisition and analysis are needed for better diagnosis of pancreatic lesions.

Prediction of Malignancy With Endoscopic Ultrasonography in Patients With Branch Duct–Type Intraductal Papillary Mucinous Neoplasm

Prediction of Malignancy With Endoscopic Ultrasonography in Patients With Branch Duct–Type Intraductal Papillary Mucinous Neoplasm

The diagnostic yield of endoscopic ultrasonography in patients with suspected Choledocholithiasis

The diagnostic yield of endoscopic ultrasonography in patients with suspected Choledocholithiasis

Tu1693 Impact of Pre-Operative Endoscopic Ultrasound in Patients Undergoing Surgery for Cystic Lesions of the Pancreas

Endoscopic ultrasound (EUS) is a standard modality in characterization of pancreatic lesions, especially in those patients who may undergo surgical resection. With increased detection of incidental pancreatic cystic lesions on routine cross sectional imaging, EUS is utilized more frequently in the work up of such patients. Furthermore there is an increasing need for reliable indicators to improve EUS accuracy in accurately identifying such lesions. Aims: To evaluate the impact of pre-operative EUS in patients who underwent surgical resection of pancreatic cystic lesions.

Tu1624 Prognostic Significance of Differentiating Peri-Pancreatic Necrosis From Fluid Collection on Endoscopic Ultrasound in Patients With Presumed Extra-Pancreatic Necrosis Alone

Tu1624 Prognostic Significance of Differentiating Peri-Pancreatic Necrosis From Fluid Collection on Endoscopic Ultrasound in Patients With Presumed Extra-Pancreatic Necrosis Alone

Prediction of Malignancy With Endoscopic Ultrasonography in Patients With Branch Duct–Type Intraductal Papillary Mucinous Neoplasm

We evaluated the accuracy of a new endoscopic ultrasonography (EUS) scoring system to predict malignancy in branch duct-type intraductal papillary mucinous neoplasms (BD-IPMNs). We performed a retrospective multicenter study of patients who underwent EUS within 3 months before surgery and were diagnosed as having BD-IPMNs by postoperative pathologies at 8 hospitals in Korea from August 2002 to December 2011. To predict the malignancy, we applied the EUS scoring system consisting of pancreatic cyst size, height of mural nodules, main duct dilatation, septal thickening, and patulous orifice. We evaluated the diagnostic accuracy of the new EUS scoring system and compared it with previous individual risk factors. Eighty-four patients (male-to-female ratio, 55:29; mean [SD] age, 64.7 [7.1] years) had 68 benign BD-IPMNs and 16 malignant intraductal papillary mucinous neoplasms. The EUS scoring system showed 75.0% sensitivity and 94.1% specificity at 7 points. This system (area under the curve, 0.939; 95% confidence interval, 0.884-0.994) resulted in a more accurate prediction than the previous known other factors including Sendai criteria, dilatation of ducts, size of the cyst, and presence of septal thickening and mural nodules. The EUS scoring system predicted BD-IPMN malignancy more accurately than the Sendai criteria and individual risk factors.

Diagnostic yield of endoscopic ultrasonography in patients with intermediate or high likelihood of choledocholithiasis: a retrospective study from one university-based endoscopy center.

BackgroundDiagnosis of choledocholithiasis requires clinical manifestations and imaging examination findings suggesting a stone in the common bile duct (CBD), but these factors are not highly sensitive or specific. The choledocholithiasis management algorithm proposed by the American Society for Gastrointestinal Endoscopy (ASGE) may not be appropriate for patients who fulfill the clinical criteria for a high likelihood of choledocholithiasis. Endoscopic ultrasonography (EUS) may replace endoscopic retrograde cholangiopancreatography (ERCP) for the detection of CBD stones in all patients. The aims of this study were to determine the diagnostic yield and optimal timing of EUS in patients with an intermediate or high likelihood of choledocholithiasis requiring therapeutic ERCP.MethodsPatients with suspected choledocholithiasis who underwent EUS between June 2009 and January 2012 were retrospectively reviewed. The patients were divided into two groups based on the likelihood of choledocholithiasis according to the clinical predictors described by the ASGE guidelines: an intermediate likelihood group and a high likelihood group. The demographic data, clinical manifestations at presentation, blood test results, EUS and ERCP findings, and clinical manifestations during the follow-up period were recorded and analyzed.ResultsNinety-three patients were enrolled in the study (52.7% in the intermediate likelihood group and 47.3% in the high likelihood group). CBD stones were detected in 22.44% of patients in the intermediate likelihood group and 38.63% of patients in the high likelihood group. EUS had a sensitivity of 100% and specificity of 80% for detection of CBD stones. An alkaline phosphatase level of >133 mg/dL (area under the curve, 0.576) was the only factor that was significantly associated with detection of CBD stones in patients who underwent EUS >7 days after the initial clinical presentation (odds ratio 4.87, p = 0.01).ConclusionsEUS is an accurate diagnostic tool for the detection of CBD stones, and can prevent the unnecessary use of ERCP. This study found that use of clinical criteria alone might not provide a good prediction of the presence of CBD stones, even in patients who fulfill the criteria for a high likelihood of choledocholithiasis.

Role of endoscopic ultrasonography in patients with first episode of idiopathic acute pancreatitis

Acute pancreatitis (AP) evades an etiological diagnosis in up to 10 % to 30 % of patients. This group, ie. idiopathic acute pancreatitis (IAP) is prone to a high recurrence (up to 70 %). Endoscopic ultrasound (EUS) is promising, but there is limited data on elucidating the cause of IAP, from India. This observational study was designed to study the role of EUS after the first episode of IAP. All patients diagnosed to have first episode of IAP were included in the study and taken up for EUS examination after 6 weeks. Patients with conditions known to predispose or precipitate AP, like alcohol binge, drugs, metabolic or autoimmune conditions, or even a positive family history, were excluded from the study. A total of 51 patients were included. EUS positivity was found in 29 (56.9 %) patients. It included common bile duct (CBD) calculus in 5 (9.8 %), CBD sludge in 4 (7.8 %), gallbladder calculus in 2 (3.9 %), gallbladder sludge in 2 (3.9 %), and chronic pancreatitis (CP) in 16 (31.4 %) patients. Fourteen patients had a normal study and eight patients had indeterminate CP. EUS is safe and has a reasonable diagnostic yield in patients with first episode of IAP. CP and biliary lithiasis are the most frequent positive findings on EUS. EUS should be included in the diagnostic protocol after the first episode of IAP, rather than waiting for recurrent episodes.

Role of Endoscopic Ultrasonography in Patients With Intermediate Probability of Choledocholithiasis But a Negative CT Scan

Despite the increased role of endoscopic ultrasonography (EUS) in diagnosis, few studies have evaluated its impact on the management of choledocholithiasis in a clinical setting for patients for whom computed tomography (CT) was conducted initially. Our aim in this study was to evaluate the role of EUS in patients with a diagnosis of intermediate probability of choledocholithiasis with a negative CT scan result. A total of 98 patients who were diagnosed with symptomatic cholelithiasis with intermediate probability of choledocholithiasis were evaluated prospectively. Twenty-six of the 98 patients (26.5%) were diagnosed with choledocholithiasis by CT scans. The remaining 72 patients underwent EUS. Twenty-five of the 72 patients were shown to have choledocholithiasis (n=20/72, 27.8%) or papillitis with biliary outflow obstruction (n=5/72, 6.9%) on EUS. These 25 patients with positive EUS findings underwent endoscopic sphincterotomy, and choledocholithiasis was endoscopically confirmed in 23 of the 25 patients (92.0%). Postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis occurred in 3 patients (12.0% of the 25 patients who received ERCP, 4.2% of all 72 patients). Forty-seven patients with no evidence of choledocholithiasis on EUS were followed-up for a median period of 340 days (range, 185 to 755 d), and no recurrent biliary events occurred in these patients during this period. The sensitivity and specificity of EUS for choledocholithiasis was 87.0% and 100%, respectively. An EUS-first strategy in patients with intermediate probability of choledocholithiasis but a negative CT scan is very useful and can reduce the need to perform invasive ERCP.

Role of Endoscopic Ultrasonography in Patients With Thickened Wall Stomach by CT Scan

The usefulness of endoscopic ultrasonography (EUS) in patients who have gastric wall thickening in computed tomography (CT) is not clear. All patients referred for EUS due to thickened gastric folds on CT were included in this study. Esophagogastroduodenoscopy (EGD) followed by EUS was performed on all patients. Twenty-eight patients were enrolled in the study. The mean ± SD age was 50.8 ± 15.9 years, and 60.7% were male. Most patients (78.6%) had symptoms, and 10 patients (35.7%) were ultimately diagnosed with a gastric neoplasm. In all patients with a normal EGD (11 patients), the EUS was normal. Accuracy, specificity, sensitivity, positive predictive value, and negative predictive value of EUS for detecting a lesion in thickened wall stomach on CT were 89.3%, 88.8%, 90.0%, 81.8%, and 94.1%, respectively. In patients with a thickened gastric wall by CT, upper gastrointestinal endoscopy should be done before endoscopic ultrasonography, with ultrasonography reserved for those patients with an abnormal EGD. Endoscopic ultrasonography has good sensitivity for lesion detection in cases with an abnormal endoscopy, and the presence of gastric symptoms increases the likelihood of abnormal EUS.

Endoscopic ultrasonography in patients with elevated carbohydrate antigen 19-9 of obscure origin

To evaluate the efficacy of endoscopic ultrasonography (EUS) in patients with elevated carbohydrate antigen (CA) 19-9 levels of obscure origin. Patients who had visited Pusan National University Hospital because of elevated serum CA 19-9 levels, between January 2007 and December 2009, were retrospectively enrolled. EUS had been performed on all subjects, in addition to routine blood tests, endoscopy, abdominal computed tomography (CT) and other clinical exams, which had not revealed any abnormal findings suggestive of the origin of the elevated CA 19-9 levels. Of the 17 patients, gallbladder sludge was detected in 16 patients (94.1%) and common bile duct sludge was observed in 3 patients (17.6%). After the administration of ursodeoxycholic acid to 12 of the patients with gallbladder sludge, CA 19-9 levels normalized in 6 of the patients after a median of 4.5 mo. EUS is a useful diagnostic method for patients with elevated CA 19-9 levels of obscure origin, even if the reason for abnormal levels of this serum marker cannot be determined through prior examinations, including abdominal CT.

Esophageal duplication cysts: Endosonographic findings in asymptomatic patients

Esophageal duplication cysts are rare inherited lesions usually diagnosed in early childhood. Most of them are found in the mediastinum and manifest themselves as separate masses along or in continuity with the native esophagus. Their prevalence remains unknown and they are treated either surgically or endoscopically. In this report we describe a series of four adult patients in whom esophageal duplication cysts were localised intramurally as masses pressing on the esophageal lumen and who were diagnosed with endoscopic ultrasonography. All patients were initially referred to other centres for upper gastroduodenoscopy due to non-specific dyspeptic symptoms. After finding suspicious lesions in the esophagus their endoscopists referred them for endoscopic ultrasound examination at our centre. In two of the cases lesions mimicked esophageal varices and the other two submucosal tumours. In all four patients endoscopic ultrasonography has shown esophageal duplication cysts. Patients had no symptoms suggesting disease of the esophagus and required no treatment. As the true prevalence of esophageal cysts is unknown, it is very likely that in many patients, like in these four described by us, they may cause no symptoms, remain undetected and require no intervention. Increasing availability of new diagnostic modalities such as endoscopic ultrasonography may change the current view regarding the prevalence of esophageal duplication cysts and prove that they may, in fact, not be such rare findings.

Role of Endoscopic Ultrasonography in Patients Suspected of Pancreatic Cancer with Negative Helical MDCT Scan

Background: In some patients suspected of pancreatic cancer, no mass can be detected by multidetector computed tomography (MDCT) scan as the cause of biliary obstruction. Methods: All patients suspected of pancreatic cancer between January 2007 and 2009 with a negative MDCT were identified from a database. Results: MDCT was performed for suspected pancreatic cancer in 290 patients, and in 258 a pancreatic mass was found. MDCT failed to establish a diagnosis in 32 patients (11%). In 23 patients (74%) with complete endoscopic ultrasonography (EUS), the cause of the obstruction was correctly diagnosed. A mass in the pancreatic head was found in 15 patients; 13 patients had a malignant tumor, and 2 patients a benign cause of obstruction. Further, EUS diagnosed 3 patients with a superficial adenoma of the papilla and 8 patients with a benign cause of the obstruction. In 5 patients EUS could not detect the cause of obstruction but finally a pancreatic malignancy was diagnosed. The positive predictive value of EUS was 86% and the negative predictive value 63%. Accuracy of MDCT and EUS decreased in the presence of pancreatitis or a biliary endoprosthesis. Conclusion: In patients suspected of pancreatic cancer in whom MDCT fails to demonstrate the cause of obstructive jaundice, EUS identifies 74% of the underlying diseases correctly.

Diagnostic accuracy and therapeutic impact of endoscopic ultrasonography in patients with intermediate suspicion of choledocholithiasis and absence of findings in magnetic resonance cholangiography

endoscopic ultrasonography (EUS) and magnetic resonance cholangiography (MRC) are the elective tests in the diagnosis of choledocholithiasis. MRC is best accepted by patients, but its sensitivity might decrease in the evaluation of microlithiasis. to evaluate the diagnostic accuracy and therapeutic impact of EUS in a prospective cohort of patients with intermediate suspicion of choledocolithiasis and no findings in MRC (normal MRC). during a period of 24 months, all the patients with clinical intermediate suspicion of choledocholithiasis and normal MRC were included. Sensitivity, specificity, diagnostic accuracy, positive predictive value (PPV) and negative predictive value (NPV) of MRC and EUS were compared, and so their impact in the management of these patients. seventy six patients were evaluated (lithiasis in 30% of them). Sensitivity and diagnostic accuracy of EUS (100%, 92%) were significantly higher than MRC values (0%, 70%) (p < 0.05). EUS findings (suspicion of choledocholithiasis) favored a significant change in therapeutic attitude (therapeutic ERCP was performed) in 38% of the patients (in which MRC had ruled out the presence of choledocholithiasis, and so, ERCP had not been performed) (p < 0.05). EUS allows the diagnosis of lithiasis in approximately 1/3 of patients with intermediate suspicion of choledocholithiasis and normal MRC. EUS findings involve a significant change in the management of these patients; this supports the use of EUS in clinical practice.