Endoscopic ultrasound versus magnetic resonance cholangiopancreatography for the diagnosis of computed tomography‐negative common bile duct stone: Prospective randomized controlled trial

Abstract

Objectives For suspected common bile duct stone (CBDS) missed on computed tomography (CT), there is no clear evidence on whether endoscopic ultrasound (EUS) or magnetic resonance cholangiopancreatography (MRCP) is the better diagnostic tool. We aimed to compare the diagnostic accuracy of EUS and MRCP for cases of missed CBDS on CT. Methods Patients suspected of having CBDS were enrolled and randomly allocated to the EUS or MRCP group. Upon the initial examination, those having CBDS or sludge formation underwent endoscopic retrograde cholangiopancreatography (ERCP), while those who were CBDS‐negative underwent a second examination with either MRCP or EUS, which was distinct from the initial diagnostic procedure. The primary outcome was diagnostic accuracy, and the secondary outcomes were diagnostic ability, detection rate and characteristics of CBDS in the second examination, and the frequency of adverse events. Results Between April 2019 and January 2021, 50 patients were enrolled in the study. The accuracy was 92.3% for EUS and 68.4% for MRCP (P = 0.055). EUS showed 100% sensitivity, 88.2% specificity, 81.8% positive predictive value, and 100% negative predictive value, and MRCP showed 33.3% sensitivity, 84.6% specificity, 50% positive predictive value, and 73.3% negative predictive value. The CBDS detection rate in the second examination was 0% for MRCP after a negative EUS and 35.7% for EUS after a negative MRCP (P = 0.041). No adverse events occurred in any of the patients. Conclusions Endoscopic ultrasound may be a superior diagnostic tool compared to MRCP for the detection of CBDS that are undetected on CT. (UMIN000036357).

Sensitivity and Specificity of Magnetic Resonance Cholangiopancreatography against Endoscopic Retrograde Cholangiopancreatography in Diagnosing Choledocholithiasis

“…A study that was conducted in the Japan showed inconsistent results with positive predictive value (50.0%) and negative predictive value (73.30%). 14 The difference in this current study results in comparison to the results of international studies could be due to various reasons such as variation in the expertise level of operators and errors in documentation. Furthermore, a study has indicated that MRCP sensitivity, specificity, and accuracy goes up when stones size gets larger and higher contrast resolution are used in diagnosing the choledocholithiasis.…”

Endoscopic Ultrasound in Pancreatology: Focus on Inflammatory Diseases and Interventions

“…One prospective RCT [3] showed no significant superiority of EUS over MRCP in diagnosing biliary disease in patients with intermediate risk of choledocholithiasis (i.e., patients with dilated CBD on ultrasound of the abdomen and/or altered LFTs). On the other hand, both a Japanese RCT conducted in patients with suspected common bile duct stones but negative computed tomography [4] and a recently published meta-analysis showed higher sensitivity and accuracy of EUS over MRCP in detecting choledocholithiasis [5]. In one prospective study in patients with idiopathic acute pancreatitis [6], EUS found more biliary stones, whereas MRCP identified pancreatic duct abnormalities with higher sensitivity.…”

Post-endoscopic retrograde cholangiopancreatography pancreatitis: a review

“…[13] Early surgical options could be considered for patients who are appropriate candidates without risks of serious complications such as cholangitis or organ dysfunction. [39] Certain groups of patients previously had high rates of ERCP such as those with high suspicion of type III SOD and were later found to have no benefit from empiric sphincterotomy. [26,43] The SOD is a concentric muscle, that responds to hormonal input, found in the pre-ampullary portion of the pancreatic and bile ducts.…”