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. 2017 Mar 15;11(2):290-297.
doi: 10.5009/gnl16052.

Diagnostic Value of Endoscopic Ultrasonography in Symptomatic Patients with High and Intermediate Probabilities of Common Bile Duct Stones and a Negative Computed Tomography Scan

Tae Joo Jeon  1   2 , Jae Hee Cho  3 , Yeon Suk Kim  3 , Si Young Song  2   4 , Ji Young Park  1
Affiliations

Diagnostic Value of Endoscopic Ultrasonography in Symptomatic Patients with High and Intermediate Probabilities of Common Bile Duct Stones and a Negative Computed Tomography Scan

Tae Joo Jeon et al. Gut Liver. .

Abstract

Background/aims: When computed tomography (CT) does not indicate choledocholithiasis in highly suspicious patients, there is no definite consensus on the subsequent modality. Endoscopic ultrasonography (EUS) indicates fewer procedure-related complications than endoscopic retrograde cholangiopancreatography (ERCP) and has a lower cost than magnetic resonance cholangiopancreatography. Therefore, we aimed to investigate the diagnostic value of EUS in patients with suspected choledocholithiasis and negative CT findings.

Methods: Between March 2008 and November 2014, we retrospectively evaluated 200 patients with negative CT findings and high or intermediate probabilities of choledocholithiasis. All patients initially underwent EUS followed by ERCP as a confirmatory criterion standard. The primary outcome in these patients was the accuracy of EUS in the detection of choledocholithiasis. The secondary outcome was the clinical prediction of common bile duct (CBD) stones in this group.

Results: EUS indicated choledocholithiasis in 165 of the 200 patients, and ERCP confirmed choledocholithiasis in 161 patients (80.5%). The accuracy of EUS in the detection of choledocholithiasis was 94.0% (sensitivity, 97.5%; specificity, 79.5%; positive predictive value, 95.2%; negative predictive value, 88.6%). A multivariate analysis demonstrated that choledocholithiasis was strongly predicted by EUS detection of choledocholithiasis, an age >55 years and a clinical diagnosis of cholangitis.

Conclusions: An EUS-first approach is recommended for patients with suspected CBD stones and negative CT findings.

Keywords: Cholangiopancreatography, endoscopic retrograde; Choledocholithiasis; Endosonography.

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Conflict of interest statement

CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Common bile duct stone findings on endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) in patients with negative computed tomography findings. (A) No choledocholithiasis is apparent on computed tomography in the coronal view. (B) A 4-mm ovoid hyperechoic lesion with posterior acoustic shadowing (white arrow) identified in the distal common bile duct during EUS. (C) A 4-mm cholesterol stone (white arrow) removed by ERCP.
Fig. 2
Fig. 2
Study flow chart. CBD, common bile duct; CT, computed tomography; EUS, endoscopic ultrasonography; ERCP, endoscopic retrograde cholangiopancreatography.
Fig. 3
Fig. 3
Suspected common bile duct (CBD) stones with a negative computed tomography scan. Patients with a high probability of choledocholithiasis; 60 of 72 patients (83.3%) had CBD stones, and endoscopic ultrasonography (EUS) indicated choledocholithiasis in 59 of 60 patients (98.3%).
Fig. 4
Fig. 4
Suspected common bile duct (CBD) stones with a negative computed tomography scan. Patients with an intermediate probability; 101 of 128 patients (78.9%) had CBD stones, and endoscopic ultrasonography (EUS) indicated choledocholithiasis in 98 of 101 patients (97%).
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