Detection of common bile duct stones: comparison between endoscopic ultrasonography, magnetic resonance cholangiography, and helical-computed-tomographic cholangiography

Kondo, Shintaro; Isayama, Hiroyuki; Akahane, Masaaki; Toda, Nobuo; Sasahira, Naoki; Nakai, Yosuke; Yamamoto, Natsuyo; Hirano, Keisuke; Komatsu, Yutaka; Tada, Minoru; Yoshida, Haruhiko; Kawabe, Takao; Ohtomo, Kuni; Omata, Masao

doi:10.1016/j.ejrad.2004.07.007

Cited by 221 publications

(138 citation statements)

References 23 publications

Supporting

Mentioning

116

Contrasting

Unclassified

Order By: Relevance

“…However, increasing evidence suggests that EUS could be more sensitive for diagnosis of small-size lithiasis (< 5 mm) (26)(27)(28)(29)(30)(31). In this respect, it has been proven that, while in patients with small-size lithiasis, EUS diagnostic accuracy remains similar as in general studies (> 90%) (26)(27)(28), sensitivity of MRC decreases significantly, and, in several studies, remains between 33 and 71% (29)(30)(31). The reason of this decrease in MRC performance for the detection of small-size (< 5 mm) lithiasis is not completely clarified.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy and therapeutic impact of endoscopic ultrasonography in patients with intermediate suspicion of choledocholithiasis and absence of findings in magnetic resonance cholangiography

Vázquez-Sequeiros

González-Panizo-Tamargo

Boixeda-Miquel

et al. 2011

Rev. esp. enferm. dig.

View full text Add to dashboard Cite

Background: endoscopic ultrasonography (EUS) and magnetic resonance cholangiography (MRC) are the elective tests in the diagnosis of choledocholithiasis. MRC is best accepted by patients, but its sensitivity might decrease in the evaluation of microlithiasis.Aim: to evaluate the diagnostic accuracy and therapeutic impact of EUS in a prospective cohort of patients with intermediate suspicion of choledocolithiasis and no findings in MRC (normal MRC).Material and methods: during a period of 24 months, all the patients with clinical intermediate suspicion of choledocholithiasis and normal MRC were included. Sensitivity, specificity, diagnostic accuracy, positive predictive value (PPV) and negative predictive value (NPV) of MRC and EUS were compared, and so their impact in the management of these patients.Results: seventy six patients were evaluated (lithiasis in 30% of them). Sensitivity and diagnostic accuracy of EUS (100%, 92%) were significantly higher than MRC values (0%, 70%) (p < 0.05). EUS findings (suspicion of choledocholithiasis) favored a significant change in therapeutic attitude (therapeutic ERCP was performed) in 38% of the patients (in which MRC had ruled out the presence of choledocholithiasis, and so, ERCP had not been performed) (p < 0.05).Conclusions: EUS allows the diagnosis of lithiasis in approximately 1/3 of patients with intermediate suspicion of choledocholithiasis and normal MRC. EUS findings involve a significant change in the management of these patients; this supports the use of EUS in clinical practice.Key words: Endoscopic ultrasonography. Magnetic resonance Cholangiography. Diagnostic accuracy. Therapeutic impact. Choledocholithiasis. INTRODUCTIONCholelithiasis is a major gastrointestinal disease, and choledocholithiasis is one of its main complications (1). The prevalence of choledocholithiasis in patients who have undergone a previous cholecystecthomy due to symptomatic cholelithiasis, and in patients with acute biliary pancreatitis, is estimated in 5-10% and 18-33%, respectively (2). Diagnosis of choledocholithiasis is based on clinical signs and symptoms, serum markers of cholestasis and imaging tests -abdominal ultrasonography and even computed tomography (CT)-(3). Since the introduction of endoscopic retrograde cholangiography (ERCP), it has been considered the gold standard for the diagnosis and eventually the nonsurgical therapeutic approach for choledocolithiasis (4). However, because of the associated risks -pancreatitis (1,3-6,7%), infection (0,6-5%), hemorrhage (0,3-2%) and perforation (0,1-1,1%)-(5-7), at the present time, ERCP is almost exclusively reserved for therapeutic purpose (8,9), and it has been replaced by less invasive tests, such as magnetic resonance cholangiography (MRC) and endoscopic ultrasonography (EUS), for the diagnosis of choledocolithiasis.In order to establish the likelihood of choledocholithiasis, different algorithms have been developed considering clinical, analytical and radiological findings; these algorithms allow us to classify patients in hi...

show abstract

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy and therapeutic impact of endoscopic ultrasonography in patients with intermediate suspicion of choledocholithiasis and absence of findings in magnetic resonance cholangiography

Vázquez-Sequeiros

González-Panizo-Tamargo

Boixeda-Miquel

et al. 2011

Rev. esp. enferm. dig.

View full text Add to dashboard Cite

show abstract

“…ALT levels three times the normal (>150 IU/L) was reported useful in diagnosis (43). Although magnetic resonance cholangiopancreatography (MRCP) is the most frequently used, it may not reveal the stone if the size of the stone is smaller than 5 mm (44). Endosonography (EUS) has a sensitivity of 89% and specificity of 96% for choledochal stone but its use is yet to be widespread (43).…”

Section: Modified Marshall 1995 ≥2mentioning

confidence: 99%

Pathophysiology, classification and available guidelines of acute pancreatitis

İnce

Baysal²

2014

Turk J Gastroenterol

View full text Add to dashboard Cite

Acute pancreatitis (AP) constitutes the majority of cases requiring hospital admission in gastroenterology. We are yet to know many things about its pathophysiology which is a certain drawback for the progress in its treatment. Prediction of severity is necessary for the plan of the management. The existing scoring systems are yet to be satisfactory. However our progress in the field was significant in the recent decade and a leap forward is expected in this cumbersome-to-manage condition which has many unmet needs. In this review, we are going to summarize the hitherto data in pathogenesis and would weigh the usefulnes and weaknes of each of existing scoring systems in the management of AP. Keywords: Acute pancreatitis, guideline, pathophysiology, scoring systems, classifications, insights Pancreas was first discovered by Herophilus, a Greek anatomist and surgeon, in Chalcedon (now Kadıkoy, Istanbul) in 336 BC. Despite the many years since its discovery, a lot remains unknown about pancreas. The coming decade would, probably, witness several advances in our understanding of pancreas and its diseases.This review aims to describe the hitherto knowledge in pancreas pathophysiology and classification systems of severity scoring. PATHOPHYSIOLOGYThe main reason for the lack of successful treatment in acute pancreatitis (AP) is that many aspects of this condition regarding the pathophysiology are still unknown. AP has a severe course in 20% of the cases and may be associated with high morbidity and mortality in 2-3%. Pancreatic autodigestion (trypsinogen-centered) theory has been in use in the AP pathogenesis for over a hundred year. In this theory, premature activation of pancreatic proenzymes (zymogens) induces autolysis, which triggers inflammatory events followed by continued damage to the pancreas and/or non-pancreatic tissues in some way.Experimental models (1,2) have demonstrated the involvement of trypsin activation in hereditary pancreatitis (3). Along with zymogen activation, natural factor kappa beta (NFkB) activation is also important in the development of AP. Whether both are involved or are independently-acting parallel factors in AP is controversial. It was shown, in vitro, that trypsinogen expression did not activate NFkB (4

show abstract

“…Additionally, EUS permits the accurate and systematic visualization of the wall of the duodenum, including the papillary region [38] . Several authors compared MRCP and EUS in detecting choledocholithiasis showing cost-effectiveness and higher accuracy of EUS in detecting distal small stones in non-dilated ducts [26,32,39] . De Lédinghen et al [39] reported a 100% negative predictive value of EUS in the diagnosis of lithiasis, thus excluding the needing for further investigation and limiting unnecessary surgery.…”

Section: Impact Of Eus In the Diagnostic Work Up Of Cbd Dilatationmentioning

confidence: 99%

“…Reported sensitivity in detection of CBD stones is 18%-74% for TUS and 50%-90% for CT [23][24][25] . Recently developed imaging modalities, such as MRCP and helical computed tomographic cholangiography (HCT-C) have shown higher sensitivity than TUS and conventional CT, and remain less invasive than ERCP [26] . However, EUS is considered more accurate in detecting CBD stones, especially if smaller than 5 mm in diameter, which are sometimes not identified by MRCP and HCTC [26] .…”

Section: Causes Of Biliary Dilatationmentioning

confidence: 99%

“…Recently developed imaging modalities, such as MRCP and helical computed tomographic cholangiography (HCT-C) have shown higher sensitivity than TUS and conventional CT, and remain less invasive than ERCP [26] . However, EUS is considered more accurate in detecting CBD stones, especially if smaller than 5 mm in diameter, which are sometimes not identified by MRCP and HCTC [26] . When choledocholithiasis is suspected, sensitivity of EUS reaches 90% for the detection of CBD stones [27][28][29] .…”

Section: Causes Of Biliary Dilatationmentioning

confidence: 99%

See 1 more Smart Citation

Endoscopic ultrasound in common bile duct dilatation with normal liver enzymes

Angelis¹,

Marietti²,

Bruno³

et al. 2015

WJGE

View full text Add to dashboard Cite

In recent years, the description of isolated bile duct dilatation has been increasingly observed in subjects with normal liver function tests and nonspecific abdominal symptoms, probably due to the widespread use of high-resolution imaging techniques. However, there is scant literature about the evolution of this condition and the impact of endoscopic ultrasound (EUS) in the diagnostic work up. When noninvasive imaging tests (transabdominal ultrasound, computed tomography or magnetic resonance cholangiopancreatography) fail to identify the cause of dilatation and clinical or biochemical alarm signs are absent, the probability of having biliary disease is considered low. In this setting, using EUS, the presence of pathologic findings (choledocholithiasis, strictures, chronic pancreatitis, ampullary or pancreatic tumors, cholangiocarcinoma), not always with a benign course, has been observed. The aim of this review has been to evaluate the prevalence of disease among nonjaundiced patients without signs of cytolysis and/or cholestasis and the assessment of EUS yield. Data point out to a promising role of EUS in the identification of a potential biliary pathology. EUS is a low invasive technique, with high accuracy, that could play a double cost-effective role: identifying pathologic conditions with dismal prognosis, in asymptomatic patients with negative prior imaging tests, and excluding pathologic conditions and further follow-up in healthy subjects. Core tip: Common bile duct dilatation, often without identified causes, in subjects with normal liver function tests and nonspecific abdominal symptoms, and absence of lesions on prior noninvasive imaging tests, is increasingly found in the clinical practice. Since the clinical suspicion for biliary pathology in that setting is usually low, and there are limited literature data, this condition is ignored. However, recent evidences show the existence of pathologies among these patients, often with a non-benign course. In this scenario, endoscopic

show abstract

Detection of common bile duct stones: comparison between endoscopic ultrasonography, magnetic resonance cholangiography, and helical-computed-tomographic cholangiography

Cited by 221 publications

References 23 publications

Diagnostic accuracy and therapeutic impact of endoscopic ultrasonography in patients with intermediate suspicion of choledocholithiasis and absence of findings in magnetic resonance cholangiography

Diagnostic accuracy and therapeutic impact of endoscopic ultrasonography in patients with intermediate suspicion of choledocholithiasis and absence of findings in magnetic resonance cholangiography

Pathophysiology, classification and available guidelines of acute pancreatitis

Endoscopic ultrasound in common bile duct dilatation with normal liver enzymes

Contact Info

Product

Resources

About