Endoscopic Ultrasound: A Meta-analysis of Test Performance in Suspected Biliary Obstruction

Garrow, Donald; Miller, Scott W.; Sinha, Debajyoti; Conway, Jason; Hoffman, Brenda J.; Hawes, Robert H.; Romagnuolo, Joseph

doi:10.1016/j.cgh.2007.02.027

Cited by 177 publications

(87 citation statements)

References 68 publications

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“…15 EUS has been shown to be effective in diagnosing the etiology of the dilated duct(s) and reduces the need for unnecessary ERCPs. 16,17 EUS is a safe procedure with very low complication rates and is often used to evaluate patients with dilated duct(s). 8 Previous studies have evaluated the utility of EUS in evaluating dilated CBD and PD.…”

Section: Discussionmentioning

confidence: 99%

Which patients with dilated common bile and/or pancreatic ducts have positive findings on EUS?

Carriere¹,

Conway²,

Evans³

et al. 2012

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Background:Patients with dilated common bile duct (CBD) (>7mm) and/or pancreatic duct (PD) on abdominal imaging are often referred for endoscopic ultrasound (EUS). In many cases, the EUS shows no obvious etiology for the dilated ducts. Objective: Find clinical factors that may predict which patients are more likely to have positive findings on EUS to explain the etiologies for the dilated ducts. Design: Retrospective database analysis. Setting: Tertiary-care university hospital. Patients: Patients referred for EUS for dilated CBD and/or PD from January 2004 to February 2010 were included in this study. Only patients without an obvious etiology for the dilated ducts on abdominal imaging were included. Interventions: An EUS was performed by using either a radial echoendoscope or a linear endoscope to evaluate the common bile duct and/or the pancreatic duct. When appropriate fine needle aspiration of the mass or cyst was performed. Main Outcome Measurements: The characteristics of patients who had positive findings on EUS to explain the etiology of their dilated PD and/or CBD. Results: A total of 140 patients were included in the study with a mean age of 64 years, 51 (36%) male and 115 (82%) white. The majority of our patients had a presenting symptom of abdominal pain 105 (75%). 49 (36%) had elevated AST or ALT, 25 (8%) had an elevated bilirubin and 13 (23%) had an elevated lipase. EUS findings explained the dilated ducts in 54 (39%) of our patients, most common diagnoses included: CBD stone in 11 (8%), non-calcific chronic pancreatitis in 9 (6%), pancreatic mass in 8 (6%), IPMN in 7 (5%). On bivarate analysis patients who were older (p = 0.006), male (p = 0.001), had elevated LFTs (p = <0.001), had elevated lipase (p = 0.021) or had dilated CBD and PD (p = 0.007) were more likely to have an etiology for their dilated duct(s) discovered on EUS. Limitations: A retrospective study with a small number of patients. Conclusion: Older patients, males and those patients presenting with concurrent elevations in the AST/ALT and/or lipase were more likely to have an underlying etiology discovered on EUS. Furthermore, EUS may detect an undiagnosed pancreatic malignancy in patients presenting with unexplained duct dilation.

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Section: Discussionmentioning

confidence: 99%

Which patients with dilated common bile and/or pancreatic ducts have positive findings on EUS?

Carriere¹,

Conway²,

Evans³

et al. 2012

jig

Self Cite

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“…lisis, cada 1 compuesto por más de 25 ensayos y más de 2500 pacientes, reportaron una sensibilidad de 89%-94% y una especificidad de 94%-95% de la USE para detectar coledocolitiasis, utilizando como estándar de oro la CPRE y la colangiografía intraoperatoria (23,24). Sin embargo, y a pesar de la utilidad demostrada de la USE como método diagnóstico, no existen estudios previos que evalúen los parámetros normales del diámetro del CBC evaluado bajo esta técnica diagnóstica en América y Europa, por lo que se decide realizar el presente estudio.…”

Section: Introductionunclassified

¿Cuál es el tamaño normal del conducto biliar común?

Zuleta

Morales²,

Regino

2017

Rev. Colomb. Gastroenterol.

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Tradicionalmente se a señalado que el Conducto biliar común (CBC) mide hasta 6 mm en pacientes con vesícula y 8 mm en los colecistectomizados sin embargo estas recomendaciones se basan en trabajos muy antiguos realizados con ecografía trans-abdominal. La ecoendoscopia es el examen con una mayor sensibilidad y especificidad para evaluar la vía biliar, sin embargo aun no se han realizado estudios en nuestra población que evalúen cual es el tamaño normal del CBC por este método.Objetivo: Evaluar el tamaño del CBC en pacientes con o sin vesícula biliarMateriales y Métodos: Se realiza un estudio descriptivo prospectivo en pacientes enviados para la realización de ecoendoscopia a la unidad de gastroenterología del Hospital El Tunal, Universidad Nacional de Colombia, se recolectaron los pacientes que fueron enviados para la realización de una ecoendoscopia diagnostica referidos para la evaluación de lesiones subepiteliales en esófago y/o estomago, una vez se realizo la evaluación de la lesión y se estableció el diagnostico ecoendoscópico, se procede a avanzar el transductor hasta la segunda porción duodenal desde donde se realiza una ecoendoscopia bilio-pancreática. Se midió el tamaño del CBC a nivel de la arteria hepática como es la recomendación para evitar de alterar el tamaño del CBC. Estos datos fueron recolectados en formularios en línea diligenciados durante el procedimiento ecoendoscópico teniendo como base Google driveResultados: El trabajo se desarrolla entre enero de 2013 y septiembre de 2013 periodo durante el cual se realizaron 100 ecoendoscopias por lesiones subepiteliales en el tracto digestivo alto. dentro de las características especificas de los pacientes se encontró que el promedio de edad fue de 55.6 años, el 65% de los pacientes fueron mujeres, el 18% de los pacientes tenían colecistectomía previa, de este grupo de pacientes el 50 % fueron mujeres, el tamaño del colédoco en promedio fue 4.88 mm (intervalo entre 2.6 – 7 mm), en el grupo de pacientes con vesícula biliar (88%) el tamaño promedio del colédoco fue de 4.16 mm (intervalo entre 2.6 – 6 mm), en el subgrupo de mujeres con vesícula intacta el CBC el promedio fue de 3.9 mm (intervalo entre 2.6 - 5 mm) y en hombres con vesícula intacta el CBC fue de 4.42 mm (intervalo entre 3-6 mm), en el grupo de pacientes colecistectomizados el tamaño promedio del colédoco fue de 4,88 mm (intervalo entre 3-7 mm), en el grupo de mujeres colecistectomizadas el promedio fue de 4.84 mm (intervalo entre 4.6 - 7 mm), en hombres colecistectomizados el promedio fue de 4.92 mm (intervalo entre 3 - 7 mm).Conclusiones: Nuestro trabajo muestra que el tamaño normal del colédoco promedio es de 4.16 mm menor a lo aceptado por la literatura y 4.88 mm en pacientes colecistectomizados , esto es interesante por que si se tiene un tamaño mayor obligaría a descartar patología bilio-pancreática con la realización de una ecoendoscopia diagnostica.

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“…Thus, ERCP is usually reserved for therapeutic interventions on the biliary tree (8,9). Non invasive techniques (EUS and MRC) avoid ERCP risks (12,13) and have a similar accuracy to that described for ERCP in detecting choledocholithiasis (85-95%) (17)(18)(19)(20). In addition, some publications have suggested that performance of EUS previously to ERCP as a non-invasive screening test in patients with intermediate likelihood for choledocholithiasis, allows to avoid ERCP in 60-73% of this patients, and consequently, reduces the morbidmortality rate and costs (21)(22)(23)(24).…”

Section: Discussionmentioning

confidence: 99%

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

Vázquez-Sequeiros

González-Panizo-Tamargo

Boixeda-Miquel

et al. 2011

Rev. esp. enferm. dig.

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Background: 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.Aim: 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).Material and methods: 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.Results: 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).Conclusions: 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.Key words: Endoscopic ultrasonography. Magnetic resonance Cholangiography. Diagnostic accuracy. Therapeutic impact. Choledocholithiasis. INTRODUCTIONCholelithiasis is a major gastrointestinal disease, and choledocholithiasis is one of its main complications (1). The prevalence of choledocholithiasis in patients who have undergone a previous cholecystecthomy due to symptomatic cholelithiasis, and in patients with acute biliary pancreatitis, is estimated in 5-10% and 18-33%, respectively (2). Diagnosis of choledocholithiasis is based on clinical signs and symptoms, serum markers of cholestasis and imaging tests -abdominal ultrasonography and even computed tomography (CT)-(3). Since the introduction of endoscopic retrograde cholangiography (ERCP), it has been considered the gold standard for the diagnosis and eventually the nonsurgical therapeutic approach for choledocolithiasis (4). However, because of the associated risks -pancreatitis (1,3-6,7%), infection (0,6-5%), hemorrhage (0,3-2%) and perforation (0,1-1,1%)-(5-7), at the present time, ERCP is almost exclusively reserved for therapeutic purpose (8,9), and it has been replaced by less invasive tests, such as magnetic resonance cholangiography (MRC) and endoscopic ultrasonography (EUS), for the diagnosis of choledocolithiasis.In order to establish the likelihood of choledocholithiasis, different algorithms have been developed considering clinical, analytical and radiological findings; these algorithms allow us to classify patients in hi...

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Endoscopic Ultrasound: A Meta-analysis of Test Performance in Suspected Biliary Obstruction

Cited by 177 publications

References 68 publications

Which patients with dilated common bile and/or pancreatic ducts have positive findings on EUS?

Which patients with dilated common bile and/or pancreatic ducts have positive findings on EUS?

¿Cuál es el tamaño normal del conducto biliar común?

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

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