The Usefulness of Early Endoscopic Ultrasonography in Acute Biliary Pancreatitis with Undetectable Choledocholithiasis on Multidetector Computed Tomography

Abstract

Background/Aims: EUS can detect bile duct stones (BDS) that are undetectable on multidetector computed tomography (MDCT). BDS associated with acute biliary pancreatitis (ABP) are small and tend to be excreted spontaneously. This study evaluated the usefulness of early EUS in patients with ABP and undetectable BDS on MDCT. Methods: Forty-one patients with ABP and undetectable BDS on MDCT underwent EUS within 24 hours of admission and were diagnosed with BDS, sludge, dilated common bile duct (CBD), or normal CBD. ERCP was performed in patients with BDS, sludge, or clinical deterioration. The diagnostic yield and the effects of early EUS on morbidity, mortality, and the length of hospitalization were evaluated. Results: EUS detected BDS or sludge in 48.8% of patients examined. BDS was the diagnosis in 13 patients, sludge in seven, and neither for 21 patients. ERCP was performed in 20 patients with BDS or sludge, in two patients with coexisting cholangitis, and in one patient with worsening liver function tests. ERCP identified BDS in 12 patients and sludge in seven. No lesions were diagnosed in four patients by ERCP. All patients improved, and the length of hospitalization in patients with ERCP was 9.0 days, without ERCP 7.1 days. Two patients with major complications by ERCP were hospitalized for a prolonged time. Conclusions: Early EUS may be useful to select patients for therapeutic ERCP in cases of suspected ABP with undetectable BDS on MDCT. (Korean J Gastroenterol 2016;68:202-209)

Present status and perspectives of endosonography 2017 in gastroenterology

“…In some cases, preliminary imaging tests (percutaneous ultrasound, computed tomography [CT], or even magnetic resonance cholangiopancreatography) may not be conclusive. In these situations, EUS might emerge, even as an emergency procedure, to guide therapeutic decisions [ 44 ]. Modern longitudinal scanners can also be used as duodenoscopes for immediate stone removal [ 45 ].…”

Intraoperative cholangiography versus magnetic resonance cholangiography in patients with mild acute biliary pancreatitis

“…[ 2 – 4 ] Acute biliary pancreatitis (ABP) results from the migration of a gallstone to the common bile duct (CBD), most of these gallstones are smaller than 5 mm in diameter. [ 3 , 5 – 8 ] Although spontaneous passage of the CBD small stones occurs in up to 50% of the cases, 20% to 30% of patients with ABP will have persistent CBD stones. [ 6 , 9 – 11 ] Thus, it is mandatory to image the CBD during inpatient admission to ensure the absence of choledocholithiasis.…”