Endoscopic Ultrasonography Can Prevent Unnecessary Diagnostic Endoscopic Retrograde Cholangiopancreatography Even in Patients with High Likelihood of Choledocholithiasis and Inconclusive Ultrasonography: Results of a Prospective Study

Abstract

Background/AimsEndoscopic retrograde cholangiopancreatography (ERCP) is the initial therapy recommended for patients with high likelihood of choledocholithiasis. To determine whether endoscopic ultrasonography (EUS) can prevent diagnostic ERCPs in patients with high probability of choledocholithiasis and inconclusive ultrasonography (US).MethodsAll patients with high likelihood of choledocholithiasis and negative US underwent EUS. ERCP was performed for the patients who showed a definite stone/sludge on EUS. Patients without choledocholithiasis were followed up for 3 months. The primary outcome was avoidance of diagnostic ERCP.ResultsWe included 78 patients (51 women; 27 men). Of these, 25 and 7 (total 41%) were diagnosed with choledocholithiasis and sludge, respectively; stone/sludge was removed in 96.9% of the patients. EUS ruled out choledocholithiasis in 38 patients (48.7%). Two of them were found to have choledocholithiasis on follow-up. The sensitivity, specificity, positive and negative predictive value of EUS for detecting choledocholithiasis were 93.9%, 97.3%, 96.9%, and 94.7%, respectively. Unnecessary ERCP was avoided in 57.7% of the patients by using the EUS-first approach.ConclusionsEUS is a highly accurate and safe procedure. EUS can replace ERCP as the initial investigation in patients with a high probability of choledocholithiasis. It avoids unnecessary ERCP; hence, decreasing related costs and complications.

The Relationship between Choledocholithiasis and Liver Enzymes in Elderly Patients

“…Para et al found that any of the studied factors such as liver enzymes and ultrasound alone could not be a suitable indicator of stone formation through a study he conducted on 151 patients who underwent ERCP (Parra et al, 2007). In another study on 78 patients performed by Patel et al, they reported that endosonography before operation can decline unnecessary ERCP procedure (Patel et al, 2017).…”

Adenomyoma of the distal common bile duct demonstrated by endoscopic ultrasound: A case report and review of the literature

“…When MRCP findings are negative in the presence of dilated CBD, EUS provides better visualization of the biliary obstruction because its transducer is close enough to the CBD in the duodenum. Patel et al[23] preferred EUS rather than ERCP as the initial investigation in patients with a probability of choledocholithiasis. Endosonography may also be useful in the evaluation of cholangiocarcinoma[24].…”

Pancreatitis poscolangiopancreatografía retrógrada endoscópica

“…Con el advenimiento de modalidades de imagen menos invasivas, la CPRE ha dejado de ser una herramienta diagnóstica de primera elección y se ha convertido en un procedimiento esencialmente terapéutico 31 . La resonancia magnética y el ultrasonido endoscópico pueden evitar la CPRE en el 30-50% y en el 36-57% de los casos, respectivamente [32][33][34][35][36] .…”