EUS versus MRCP to perform ERCP in patients with intermediate likelihood of choledocholithiasis: a randomised controlled trial

Jagtap, Nitin; Kumar, JK; Chavan, Radhika; Basha, Jahangeer; Tandan, Manu; Lakhtakia, Sundeep; Kalapala, Rakesh; Nabi, Zaheer; Gupta, Rajesh; Ramchandani, Mohan; Talukdar, Rupjyoti; Reddy, Manohar; Yarlagadda, Raghavendra; Singh, Jagdeep; Memon, Sana Fatima; Rao, G Sudhakara; Reddy, D. Nageshwar

doi:10.1136/gutjnl-2021-325080

Cited by 23 publications

(16 citation statements)

References 20 publications

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“…Many other studies that evaluated the diagnosis of choledocholithiasis by EUS showed variable results regarding sensitivities and specificities. For example, Jagtap et al [ 13 ] showed that the sensitivities of both EUS and MRCP were similarly high (92%-98%). Also, Patel et al [ 11 ] showed that the sensitivity and specificity of EUS were 93% and 97.3%, respectively, but most included patients had a high probability of choledocholithiasis.…”

Section: Discussionmentioning

confidence: 99%

Role of endoscopic ultrasound in evaluation of patients with missed common bile duct stones

Eissa¹,

Okasha²,

Abbasy³

et al. 2022

WJGE

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BACKGROUND Choledocholithiasis develops in up to 20% of patients with gall bladder stones. The challenge in diagnosis usually occurs with small stones that may be missed by magnetic resonance cholangiopancreatography (MRCP). Endoscopic ultrasound (EUS) is accurate in detecting common bile duct (CBD) stones missed by MRCP, especially the small ones or those impacted at the distal CBD or the papillary region. AIM To evaluate the accuracy of EUS in detecting CBD stones missed by MRCP. METHODS Patients with an intermediate likelihood of choledocholithiasis according to ESGE guidelines and those with acute pancreatitis of undetermined cause were included. The presence of choledocholithiasis was evaluated by MRCP and EUS, and then results were confirmed by endoscopic retrograde cholangiopancreatography (ERCP). The sensitivity and specificity of EUS and MRCP were compared regarding the presence of stones, the size, and the number of detected stones. RESULTS Ninety out of 100 involved patients had choledocholithiasis, while ten patients were excluded as they had pancreatic or gall bladder masses during EUS examination. In choledocholithiasis patients, the mean age was 52.37 ± 14.64 years, and 52.2% were males. Most patients had biliary obstruction (74.4%), while only 23 (25.6%) patients had unexplained pancreatitis. The overall prevalence of choledocholithiasis was 83.3% by EUS, 41.1% by MRCP, and 74.4% by ERCP. Also, the number and size of CBD stones could be detected accurately in 78.2% and 75.6% by EUS and 41.1% and 70.3% by MRCP, respectively. The sensitivity of EUS was higher than that of MRCP (98.51% vs 55.22%), and their predictive value was statistically different ( P < 0.001). Combination of both tools raised the sensitivity to 97.22% and specificity to 100%. CONCLUSION EUS could be a useful tool in assessing patients with suspected choledocholithiasis especially if combined with MRCP. However, its usefulness depends on its availability and the experience of the local centers.

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Section: Discussionmentioning

confidence: 99%

Role of endoscopic ultrasound in evaluation of patients with missed common bile duct stones

Eissa¹,

Okasha²,

Abbasy³

et al. 2022

WJGE

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“…23 Nitin et al stated that sensitivity of ERCP and MRCP is 90% and 80% respectively in the detection of choledocholithiasis. 24 Recently a study conducted in USA by David et al reported that in the cases of choledocholithiasis abnormally dilatation of CBD causes reduced sensitivity of MRCP, so ERCP is suitable in such cases. 25 However previous literature states usefulness of MRCP with minimum complications and higher diagnostic accuracy in biliary obstruction.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Magnetic Resonance Cholangiopancreatography in Comparison to Endoscopic Retrograde Cholangiopancreatography in Obstructive Biliopathy

Naich¹,

Hussain²,

Zamir³

et al. 2022

PJMHS

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Objective: To determine the diagnostic accuracy of magnetic-resonance-cholangio-pancreatography (MRCP) in diagnosis of obstructive biliopathy in comparison to endoscopic retrograde cholangio-pancreatography (ERCP) taking as gold standard. Study design: It is a cross sectional study. Place and duration of study: Study was conducted on the patients admitted in the gastroenterology department of Sir Ganga Ram Hospital Lahore. Study was completed in six months duration from January 2022 to June 2022. Methodology: Patients with the suspicion of obstructive biliopathies requiring ERCP were included in this study. Study sample was divided into two groups, in one group ERCP was done while other group underwent MRCP. Resulst of both techniques were reviewed by radiologist and gastroenterologist and compared with each other considering ERCP as gold standard. P-value <0.05 was considered statistically significance. Confidence interval was 95%. Results: Total 130 cases were divided into two groups with equal number of 65 patients in each. There were 75(57.6%) female and 55(42.3%) male cases. Mean age of the patients was 43.7± 3.5 years. Sensitivity of MRCP for obstructive biliopathies was 92.4%, specificity 90.7%, positive predictive value 88.3% and negative predictive value 89.2%. Conclusion: MRCP is a non-invasive investigation of choice in obstructive biliopathies having high diagnostic accuracy avoiding unnecessary complications of ERCPs. Keywords: MRCP, ERCP, Obstructive Biliopathy, CBD Stone, Stricture

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“…The choice between MRCP or EUS is driven by local availability of resources or expertise and preference of healthcare professional or patient as EUS and MRCP have comparable sensitivity and specificity. 11 However, usage of IOC during cholecystectomy might be more cost-effective for intermediate likelihood group compared with EUS/MRCP followed by ERCP and subsequent cholecystectomy or it can be substratified to reduce need for EUS or MRCP. 12 13…”

Section: Discussionmentioning

confidence: 99%

Indian Survey on Management of Choledocholithiasis—Opportunities for Improvement and Future Studies

Jagtap

Waghmare

Giri

et al. 2022

Journal of Digestive Endoscopy

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Background In clinical practice, decision about management of choledocholithiasis is driven by availability of resources and expertise, patients and healthcare professional preferences. This survey is aimed to describe the approach of physicians and surgeons for the management of choledocholithiasis. Method A 36-question online survey was conducted using Google Forms on various aspects of management of choledocholithiasis. Results The responses from 323 participants were included, of which 202 (62.54%) were physicians and 121 (37.46%) were surgeons. The proportion of responders who do not follow American or European Society of Gastrointestinal Endoscopy guidelines is associated with increasing age and experience of responders (p = 0.0001), while place of work (private vs. teaching) and broad specialty (physician vs surgeon) are not associated (p >0.05). For patients with high likelihood of choledocholithiasis, 123 (38.1%) participants prefer to do endoscopic ultrasound/magnetic resonance cholangiopancreatography (EUS/MRCP) rather than directly performing endoscopic retrograde cholangiopancreatography/intraoperative cholangiography (ERCP/IOC). For intermediate likelihood, MRCP is more commonly preferred compared with EUS, due to local availability (44%), expertise (39.6%), healthcare professionals preference (30.7%), and patients preference (17.3%). For difficult common bile duct (CBD) stones, short biliary sphincterotomy with large balloon sphincteroplasty (59.4%), followed by laparoscopic CBD exploration are commonly used approaches. Prophylactic CBD stent placement after ERCP and CBD clearance is common practice. Preoperative ERCP followed by cholecystectomy is more preferred approach than cholecystectomy and CBD exploration. Conclusion There is considerable variability in the management of choledocholithiasis. The practices such as use of EUS/MRCP for high likelihood group, use of prophylactic CBD stent placement after ERCP and CBD clearance, and use of single stage approach especially in patient with intermediate likelihood group should be addressed in future studies.

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EUS versus MRCP to perform ERCP in patients with intermediate likelihood of choledocholithiasis: a randomised controlled trial

Cited by 23 publications

References 20 publications

Role of endoscopic ultrasound in evaluation of patients with missed common bile duct stones

Role of endoscopic ultrasound in evaluation of patients with missed common bile duct stones

Diagnostic Accuracy of Magnetic Resonance Cholangiopancreatography in Comparison to Endoscopic Retrograde Cholangiopancreatography in Obstructive Biliopathy

Indian Survey on Management of Choledocholithiasis—Opportunities for Improvement and Future Studies

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