Comparing the efficacy of EUS versus MRCP with ERCP as gold standard in patients presenting with partial biliary obstruction – finding a better diagnostic tool

Abstract

Objective: To evaluate the diagnostic accuracy of different imaging modalities in patients with partial biliary obstruction with no obvious aetiology on initial imaging.
 Methods: This is a prospective single-centre cohort study carried out at Pak Emirates Military Hospital, Rawalpindi from June 2019 to June 2021 with non-probability consecutive sampling. Patients with ages 16 to 75 years, presenting with partial biliary obstruction and undetermined aetiology on initial imaging (TUS and MRCP) were enrolled. EUS was performed for each of these patients and the case was regarded as “true positive” or “true negative” if the findings of imaging modality correlated to those of ERCP. ROC curve, sensitivity, specificity, PPV, NPV and AUC (with 95% confidence interval) were drawn for all the diagnostic tools using SPSS V. 21.
 Results: A total of 65 patients were enrolled over a period of two years with male to female ratio of 1.4:1. Forty-four patients had an intermediate risk of choledocholithiasis upon preliminary evaluation whereas, 48(74%) of the participants had CBD calculi or sludge confirmed upon subsequent ERCP. Trans-abdominal ultrasound showed the lowest sensitivity (29.2%), specificity (85%), NPV 12% and PPV 93% for diagnosing CBD calculi. This was followed by MRCP with a sensitivity of 37.5%, specificity of 100%, NPV of 36.2% and PPV of 100%. EUS showed the maximum diagnostic accuracy with AUC of 1.0 and a 100% sensitivity and specificity when compared with ERCP as gold standard.
 Conclusion: EUS is superior to MRCP in terms of diagnostic accuracy as minimally invasive diagnostic tool and EUS superiority is particularly relevant in patients with intermediate risk of choledocholithiasis.
 doi: https://doi.org/10.12669/pjms.39.5.7280
 How to cite this: Khan RSA, Alam L, Khan ZA, Khan UA. Comparing the efficacy of EUS versus MRCP with ERCP as gold standard in patients presenting with partial biliary obstruction – finding a better diagnostic tool. Pak J Med Sci. 2023;39(5):---------. doi: https://doi.org/10.12669/pjms.39.5.7280
 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Comparison of Endoscopic Ultrasound and Transabdominal Ultrasound in the Detection of Gallbladder and Common Bile Duct Microlithiasis

“…These results indicate a high number of false negatives for TUS in this study. Similar findings were reported by Khan and colleagues, who also found a low sensitivity of 29.2% [ 13 ]. Additionally, Makmun et al observed a low sensitivity range of 15-40% for detecting bile duct stones (choledocholithiasis) [ 14 ].…”

“…This finding aligns with the study conducted by Bansal and colleagues, where they concluded that the mean age of patients was 47.9 ± 18.87 years, with 54.7% female sufferers in the majority, compared to 45.3% male, contradicting the outcomes of multiple studies [ 9 ]. In contrast, Anwer et al [ 10 ], Wang et al [ 11 ], Netinatsunton et al [ 12 ], and Khan et al [ 13 ] found that 51.2%, 58.4%, 41.1%, and 58.5% of males were more affected and showed a high tendency to develop CBD stones than females, with mean ages of 50, 59, 55, and 50 years, respectively.…”

“…Post-procedural complications were notably absent in individuals undergoing EUS. Conversely, 6.3% of those undergoing ERCP encountered adverse events, such as mild pancreatitis, hemorrhage secondary to sphincterotomy, and sphincterotomy-associated perforations, necessitating prolonged hospitalization durations [ 13 ].…”