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, Enrique; González-Panizo-Tamargo, Fernando; Boixeda-Miquel, Daniel; Milicua, José

doi:10.4321/s1130-01082011000900005

Cited by 20 publications

(12 citation statements)

References 30 publications

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“…First, because it has been demostrated that early EUS has a higher successful examination rate (100 vs. 86%) and a lower morbidity (7% vs. 14%) compared with ERCP (14). In addition, EUS has demonstrated an excellent performance for the detection of small size (median of 4 mm) CBD stones (15), which may be useful in the context of biliary pancreatitis where we showed the risk of CL was significantly lower (36.2%) than without pancreatitis (65.9%) (OR 0.30; 95% CI, 0.17-0.55, p < 0.001).…”

Section: Discussionmentioning

confidence: 99%

Accuracy of ASGE criteria for the prediction of choledocholithiasis

Rivera¹,

Gonzalez²,

Monreal-Robles³

et al. 2016

Rev Esp Enferm Dig

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Background/aims: Few studies have validated the performance of guidelines for the prediction of choledocholithiasis (CL). Our objective was to prospectively assess the accuracy of the American Society for Gastrointestinal Endoscopy (ASGE) guidelines for the identification of CL.Methods: A two-year prospective evaluation of patients with suspected CL was performed. We evaluated the ASGE guidelines and its component variables in predicting CL.Results: A total of 256 patients with suspected CL were analyzed. Of the 208 patients with high-probability criteria for CL, 124 (59.6%) were found to have a stone/sludge at endoscopic retrograde cholangiopancreatography (ERCP). Among 48 patients with intermediate-probability criteria, 21 (43.8%) had a stone/ sludge. The performance of ASGE high-and intermediate-probability criteria in our population had an accuracy of 59.0% (85.5% sensitivity, 24.3% specificity) and 41.0% (14.4% sensitivity, 75.6% specificity), respectively. The mean ERCP delay time was 6.1 days in the CL group and 6.4 days in the group without CL, p = 0.638. The presence of a common bile duct (CBD) > 6 mm (OR 2.21; 95% CI, 1.20-4.10), ascending cholangitis (OR 2.37; 95% CI, 1.01-5.55) and a CBD stone visualized on transabdominal US (OR 3.33; 95% CI, 1.48-7.52) were stronger predictors of CL. The occurrence of biliary pancreatitis was a strong protective factor for the presence of a retained CBD stone (OR 0.30; 95% CI,.Conclusions: Irrespective of a patient's ASGE probability for CL, the application of current guidelines in our population led to unnecessary performance of ERCPs in nearly half of cases.

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Section: Discussionmentioning

confidence: 99%

Accuracy of ASGE criteria for the prediction of choledocholithiasis

Rivera¹,

Gonzalez²,

Monreal-Robles³

et al. 2016

Rev Esp Enferm Dig

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“…(64) Due to its higher accuracy in detecting choledocolithiasis, EUS can be performed in patients with a suspected biliary etiology, even when an MRCP fails to revealing the etiology of biliary obstruction. (65) Moreover, EUS can help identify other potential etiologies for AP including pancreas divisum and pancreatic neoplasms. (66, 67) Patients found to have evidence of choledocolithiasis and/or cholangitis should be considered for endoscopic retrograde cholangiopancreatography with sphincterotomy and clearance of the duct.…”

Section: Limiting Progression From Ap To Rap and Cpmentioning

confidence: 99%

Genetics of acute and chronic pancreatitis

Mounzer

Whitcomb²

2013

Current Opinion in Gastroenterology

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Purpose of review Acute pancreatitis (AP), recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP) are interrelated and progressive inflammatory disorders of the pancreas with highly variable and complex susceptibility, severity and outcomes. The role of genetics in AP, RAP and progression to CP within a new framework is needed. Recent findings The first genome-wide association study in pancreas has been published with genome-wide significance linked with non-coding variants at the PRSS1-PRSS2 locus on chromosome 7 and the CLDN2 locus on the X chromosome. A new personalized medicine paradigm is considered to facilitate organization of genetic and other susceptibility risk compared to risk of disease progression or resolution and risk of complications. Summary A new framework for organizing multiple, complex data sets is emerging. The role of genetics in the context of other variables, is important in understanding susceptibility to RAP and in the modification of disease severity and progression to CP. Questions of when to order testing, what to order and how to use the data in real time remains an area for future research and development.

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“…However, it is difficult to determine the prevalence of gallstones in the general population because biliary stone disease is often asymptomatic. Only one-third of gallstones cause symptoms or complications, such as choledocholithiasis [ 1 - 3 ].…”

Section: Introductionmentioning

confidence: 99%

Sensitivity and Specificity of Magnetic Resonance Cholangiopancreatography versus Endoscopic Ultrasonography against Endoscopic Retrograde Cholangiopancreatography in Diagnosing Choledocholithiasis: The Indonesian Experience

2017

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Background/AimsBiliary stone disease is one of the most common conditions leading to hospitalization. In addition to endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP) are required in diagnosing choledocholithiasis. This study aimed to compare the sensitivity and specificity of EUS and MRCP against ERCP in diagnosing choledocholithiasis. MethodsThis retrospective study was conducted after prospective collection of data involving 62 suspected choledocholithiasis patients who underwent ERCP from June 2013 to August 2014. Patients were divided into two groups. The first group (31 patients) underwent EUS and the second group (31 patients) underwent MRCP. Then, ERCP was performed in both groups. Sensitivity, specificity, and diagnostic accuracy of EUS and MRCP were determined by comparing them to ERCP, which is the gold standard. ResultsThe male to female ratio was 3:2. The mean ages were 47.25 years in the first group and 52.9 years in the second group. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for EUS were 96%, 57%, 87%, 88%, and 80% respectively, and for MRCP were 81%, 40%, 68%, 74%, and 50%, respectively.ConclusionsEUS is a better diagnostic tool than MRCP for diagnosing choledocholithiasis.

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

Cited by 20 publications

References 30 publications

Accuracy of ASGE criteria for the prediction of choledocholithiasis

Accuracy of ASGE criteria for the prediction of choledocholithiasis

Genetics of acute and chronic pancreatitis

Sensitivity and Specificity of Magnetic Resonance Cholangiopancreatography versus Endoscopic Ultrasonography against Endoscopic Retrograde Cholangiopancreatography in Diagnosing Choledocholithiasis: The Indonesian Experience

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