Comparing cost-effectiveness between endoscopic ultrasound and endoscopic retrograde cholangiopancreatography in diagnosis of common bile duct stone in patients with predefined risks: A study from a developing country

Abstract

Background and Objectives:Endoscopic ultrasound (EUS) achieves results comparable to endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of common bile duct (CBD) stone, but studies from the western have shown EUS to be less expensive in patients with intermediate risk for CBD stones. The aim of this study was to compare the costs of EUS and ERCP in the diagnosis of CBD stones in a developing country.Materials and Methods:A prospective study was done with 141 patients with suspected CBD stones, categorized as having high or intermediate risk for CBD stone. All underwent EUS, and the high-risk patients had ERCP after the EUS. For intermediate-risk patients, an ERCP was done at the discretion of the attending physician. The CBD stone was confirmed by ERCP in patients who underwent both EUS and ERCP. Patients who received EUS only were followed up every 3 months for 1 year. The false negative rate in patients with EUS and ERCP was estimated in the clinical follow-up.Result:One hundred and forty-one patients (141: 83 females, 58 males) with a mean age ± standard deviation (SD) of 55.71 ±18.68 years were recruited. Ninety-four (94) patients underwent both EUS and ERCP. ERCP confirmed the diagnosis in 83 of 85 patients (97.6%) with CBD stone detected by EUS. Forty-seven (47) patients with a negative EUS and no ERCP done were symptom-free during the follow-up. The overall sensitivity, specificity, positive predictive value, and negative predictive value of EUS were 97.6%, 80%, 97.6%, and 80% respectively. An EUS-based strategy for high-risk patients was 15% more expensive than an ERCP-based strategy, but the EUS-based strategy reduced the cost to 37.78% less than the ERCP-based strategy in intermediate-risk patients. The EUS-based strategy was cost-saving when the CBD stone prevalence was less than 52.5%.Conclusion:EUS is safer and less costly than ERCP for CBD stone diagnosis in patients with intermediate risk.

Diagnostic Accuracy of Endoscopic Ultrasonography Versus the Gold Standard Endoscopic Retrograde Cholangiopancreatography in Detecting Common Bile Duct Stones

“…In our study, we are observing the diagnostic accuracy of EUS versus ERCP which is the gold standard in detecting choledocholithiasis. In multiple studies, the majority of individuals reported a mean age of 55-59 years with the genetic predilection of disease directed towards male gender [ 11 , 12 ], while one study conducted in the same accord reported female gender to be more affected [ 10 ]. Majority of individuals presented with upper abdominal pain, jaundice, dilated CBD stones, acute or biliary pancreatitis, ultrasound or CT scan detections suggestive of stone [ 11 , 12 ].…”

“…In multiple studies, the majority of individuals reported a mean age of 55-59 years with the genetic predilection of disease directed towards male gender [ 11 , 12 ], while one study conducted in the same accord reported female gender to be more affected [ 10 ]. Majority of individuals presented with upper abdominal pain, jaundice, dilated CBD stones, acute or biliary pancreatitis, ultrasound or CT scan detections suggestive of stone [ 11 , 12 ]. The predominant category reported among sufferers of CBD stones was the intermediate-risk category [ 10 , 11 ], while in a study conducted in Taiwan, males suffered more than females and the majority of patients were categorized as high-risk patients.…”

“…Majority of individuals presented with upper abdominal pain, jaundice, dilated CBD stones, acute or biliary pancreatitis, ultrasound or CT scan detections suggestive of stone [ 11 , 12 ]. The predominant category reported among sufferers of CBD stones was the intermediate-risk category [ 10 , 11 ], while in a study conducted in Taiwan, males suffered more than females and the majority of patients were categorized as high-risk patients. EUS detected CBD stones in a maximum number of high-risk patients as compared to intermediate risk.…”

When Does Assessment for Bile Duct Stones Need to Be Performed Prior to Cholecystectomy for Calculus Gallbladder Disease?

“…6 Initial MRCP or EUS to triage patients for ERCP appears to be cost effective when compared with direct ERCP. 7,8 Although a recent study from the United Kingdom indicated that preoperative imaging with MRCP might be more cost effective than EUS, 9 the choice of test must be weighed carefully and may be determined by patient-specific factors. MRCP is noninvasive and may be favored in patients who are at above average risk for procedural sedation.…”

Endoscopic transduodenal cholecystolithotomy and cholecystolithotripsy

“…Laparoscopic cholecystectomy is generally accepted as the gold standard treatment for symptomatic gallstones [1,2]. For patients who are not suitable operative candidates, endoscopic ultrasound (EUS)-guided cholecystoduodenostomy or cholecystogastrostomy can be performed using a double-flanged, fully covered, metal stent as a bridge to further transduodenal or transgastric cholecystolithotomy [3,4].…”