Endoscopic ultrasound versus endoscopic retrograde cholangiography for the diagnosis of choledocholithiasis: the influence of the size of the stone and diameter of the common bile duct

Abstract

-Background -Endoscopic retrograde cholangiography is highly accurate in diagnosing choledocholithiasis, but it is the most invasive of the available methods. Endoscopic ultrasonography is a very accurate test for the diagnosis of choledocholithiasis with a risk of complications similar to that of upper gastrointestinal endoscopy. Aim -To compare the accuracy of endoscopic ultrassonography and endoscopic retrograde cholangiography in the diagnosis of common bile duct stones before laparoscopic cholecystectomy and to analyze endoscopic ultrasound results according to stone size and common bile duct diameter. Patients and Methods -Two hundred and fifteen patients with symptomatic gallstones were admitted for laparoscopic cholecystectomy. Sixty-eight of them (31.7%) had a dilated common bile duct and/or hepatic biochemical parameter abnormalities. They were submitted to endoscopic ultrassonography and endoscopic retrograde cholangiography. Sphincterotomy and sweeping of the common bile duct were performed if endoscopic ultrassonography or endoscopic retrograde cholangiography were considered positive for choledocholithiasis. After sphincterotomy and common bile duct clearance the largest stone was retrieved for measurement. Endoscopic or surgical explorations of the common bile duct were considered the gold-standard methods for the diagnosis of choledocholithiasis. Results -All 68 patients were submitted to laparoscopic cholecystectomy with intraoperative cholangiography with confirmation of the presence of gallstones. Endoscopic ultrassonography was a more sensitivity test than endoscopic retrograde cholangiography (97% vs. 67%) for the detection of choledocholithiasis. When stones >4.0 mm were analyzed, endoscopic ultrassonography and endoscopic retrograde cholangiography presented similar results (96% vs. 90%). Neither the size of the stone nor the common bile duct diameter had influence on endoscopic ultrasonographic performance. Conclusions -For a group of patients with an intermediate or moderate risk with respect to the likelihood of having common bile duct stones, endoscopic ultrassonography is a better test for the diagnosis of choledocholithiasis when compared to endoscopic retrograde cholangiography mainly for small-sized calculi. HEADINGS -Endosonography. Cholangiopancreatography, endoscopic retrograde. Choledochotilhiasis, diagnosis. Common bile duct.

Triple non-invasive diagnostic test for exclusion of common bile ducts stones before laparoscopic cholecystectomy

“…Due to fewer intraoperative cholangiographies during laparoscopic cholecystectomies [6,7] , ERCP has been recommended for pre-or postoperative extraction of CBDS. It is however, an invasive investigation with high risk for complications and should be reserved for selected cases [12,14,15] . MRCP is not available in all institutions and its accuracy depends on the size and position of CBDS [4,11,12] .…”

“…MRCP is not available in all institutions and its accuracy depends on the size and position of CBDS [4,11,12] . There is thus a need for easy-performing, non-invasive, and reliable test modalities to diagnose or exclude CBDS, by which selected patients can benefit from ERCP, MRCP or other expensive investigations [13][14][15] . Earlier studies on some clinical, laboratory or radiological variables have been performed [16,17] .…”

“…Ultrasonographic investigation is a reliable diagnostic modality with high availability and lower cost. However, the result of the investigation depends highly on investigators experience [3,14,20] . In our study, ultrasonography was performed by one radiologist and our results are comparable with earlier reports [3,6] .…”

The Usefulness of Early Endoscopic Ultrasonography in Acute Biliary Pancreatitis with Undetectable Choledocholithiasis on Multidetector Computed Tomography

“…20 Our results indicated that four patients diagnosed with BDS or sludge on EUS had none on ERCP; this may be caused by the passage of small stones in the interval between the two procedures, or the stones may not have been visible on fluoroscopy. 28 In this study, biliary pancreatitis was diagnosed when the values of one or more biochemical tests were greater than or equal to the cutoff values for ALP, ALT, and bilirubin. 13 These cutoff values can adequately separate the biliary from the non-biliary groups with a sensitivity of 73%, specificity of 94%, positive predictive value of 97%, and negative predictive value of 57%.…”

I Consenso Brasileiro de Ecoendoscopia

“…Para diagnóstico de cálculos da via biliar principal < ou = a 3 mm, a EE tem maior sensibilidade diagnóstica do que os métodos acima mencionados (12,26,32,33) .…”