Diagnostic Accuracy of Ultrasound, Computed Tomography, and Endoscopic Retrograde Cholangiopancreatography in the Detection of Obstructive Jaundice

Abstract

The purpose of this prospective study was to investigate the diagnostic accuracy of ultrasound (US), computed tomography (CT), and endoscopic retrograde cholangiopancreatography (ERCP) in the distinction between extrahepatic and intrahepatic causes of jaundice. The limit for the inclusion to the study was defined as a serum bilirubin concentration greater than or equal to 40 mumol/l. Altogether 187 jaundiced patients were studied. The sensitivities of US, CT, and ERCP were 63%, 77%, and 87%, respectively. The differences between all these methods were statistically significant. The specificities and positive predictive values were high, reaching 96-99%, but the negative predictive values were low, ranging between 38% and 60%. Choledochal stone disease constituted the main etiology of false-negative studies in all investigations. Imaging procedures have a prominent role in the diagnostic study of the jaundiced patient, but it is obvious that their diagnostic accuracy may vary between institutions because of the variance in local experience and expertise, and because of the differences in diseases causing jaundice.

An Experience in Management of Surgical Obstructive Jaundice

“…Lindberg et al studied 64 cases of bile duct obstruction [17J and observed gall stone disease in 29 patients, pancreatitis in I patient, sclerosing cholangitis in 2 patients, pancreatic carcinoma in 18 patients, bile duct carcinoma in 9 patients, and gall bladder carcinoma in 5 patients. In another recent study [18] of 49 patients with extrahepatic jaundice, choledochal stone (72%) was the most common benign cause while pancreatic carcinoma (52%) was the most common malignant lesion. In our study, the Surgery of Obstructive Jaundice 77 cause of biliary obstruction was pancreatic cancer (34%), choledocholithiasis (27%), carcinoma of the gall bladder (II %) and cholangiocarcinoma (11%).…”

Bile duct adenocarcinoma mimicking veno-occlusive disease after autologous bone marrow transplantation for acute leukaemia

“…In most cases of post-hepatic icterus ERCP is diagnostic particularly in combination with CT and US. 9 However, in cholangiocellular carcinoma some drawbacks of ERCP are known. 10,11 As ERCP was non-diagnostic an intrahepatic nature of the icterus was assumed necessitating a histologic diagnosis.…”

Cat scratch disease as a rare cause of obstructive jaundice: a case report

“…The most common causes depend on the population studied and include neoplasm (ranging from 18 to 86%) [1][2][3], calculous disease (varying from 5 to 48%) [1][2][3], and pancreatitis (in 2-27% of patients studied) [1][2][3]. Recently, we encountered a diagnostic challenge of a patient in whom silent obstructive jaundice developed, which proved to be of an etiology not previously reported.…”

“…Ultrasonography has become the first imaging modality in obstructive jaundice; it has the ability to define the cause and level of obstruction [1][2][3]. The most common causes depend on the population studied and include neoplasm (ranging from 18 to 86%) [1][2][3], calculous disease (varying from 5 to 48%) [1][2][3], and pancreatitis (in 2-27% of patients studied) [1][2][3].…”