Usefulness of endoscopic ultrasonography in the clinical suspicion of biliary disease

Pozo, David; Tabernero, Susana; Poves, Elvira; Sanz, Clara; Beceiro, Inmaculada; Costero, Belén; Villafruela, Mónica; Borrego, Gloria

doi:10.4321/s1130-01082011000700002

Cited by 7 publications

(3 citation statements)

References 40 publications

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“…In most studies, the mortality rate of the laparoscopic exploration of the main bile duct is 0 to 1% in the hands of experienced biliary surgeons. This rate is similar to the incidence found in the open exploration of the bile duct, [37][38][39][40][41] as well as for the endoscopic approach (0-1.5%). [42][43][44] Some authors describe postoperative bleeding as a very rare complication but one which is responsible in most cases for early reintervention.…”

Section: Discussionsupporting

confidence: 84%

Results Obtained with the Laparoscopic Approach to the Bile Duct for the Treatment of Choledocholithiasis in 101 Cases

Arnau¹,

Blanco²,

Santos³

et al. 2021

World Journal of Laparoscopic Surgery With DVD

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Section: Discussionsupporting

confidence: 84%

Results Obtained with the Laparoscopic Approach to the Bile Duct for the Treatment of Choledocholithiasis in 101 Cases

Arnau¹,

Blanco²,

Santos³

et al. 2021

World Journal of Laparoscopic Surgery With DVD

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“…Such test allows to identify choledochal lithiasis with greater sensitivity than MRC and a high negative predictive value. This might have prevented some of our 8 "blank" ERCP procedures from taking place (38,39).…”

Section: Discussionmentioning

confidence: 99%

Influence of delayed cholecystectomy after acute gallstone pancreatitis on recurrence. Consequences of lack of resources

et al. 2016

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Introduction: Acute pancreatitis is often a relapsing condition, particularly when its triggering factor persists. Our goal is to determine the recurrence rate of acute biliary pancreatitis after an initial episode, and the time to relapse, as well as to identify the risk factors for recurrence. Material and method:We included all patients admitted for a first acute gallstone pancreatitis event during four years. Primary endpoints included readmission for recurrence and time to relapse.Results: We included 296 patients admitted on a total of 386 occasions. The incidence of acute biliary pancreatitis in our setting is 17.5/100,000 population/year. In all, 19.6% of pancreatitis were severe (22.6% of severe acute pancreatitis for first episodes versus 3.6% for recurring pancreatitis), with an overall mortality of 4.4%. Overall recurrence rate was 15.5%, with a median time to relapse of 82 days. In total, 14.2% of patients relapsed after an acute pancreatitis event without cholecystectomy or endoscopic retrograde cholangio-pancreatography. Severe acute pancreatitis recur in 7.2% of patients, whereas mild cases do so in 16.3%, this being the only risk factor for recurrence thus far identified.Conclusions: Patients admitted for pancreatitis should undergo cholecystectomy as soon as possible or be guaranteed priority on the waiting list. Otherwise, endoscopic retrograde cholangio-pancreatography with sphincterotomy may be an alternative to surgery for selected patients.

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“…In this issue of the Journal, Del Pozo et al (2) assess EUS diagnostic accuracy in patients with a low or intermediate probability for BT disease, excluding those who had a dilated BT and/or a high suspicion for pathology. Abdominal US for these patients was normal, and based on well-established clinical criteria (3) a radial EUS was performed with ERCP (or surgery, e. g., for microlithiasis) indicated for positive findings.…”

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confidence: 99%

The role of endoscopic ultrasonography in the biliary tract: A great friend of ERCP's

Pérez-Cuadrado

2011

Rev. esp. enferm. dig.

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Endoscopic ultrasonography (EUS) is unstoppably entering our Units' endoscopic armamentarium. The usefulness of this technique for patients with cancer or otherwise is increasing with an ongoing refinement of accuracy and a continuous expansion towards a varied therapeutic range. Being a mixed endoscopic and sonographic technique, EUS also benefits from advances such as Doppler, contrast enhancement, and elastography. Basically, EUS-related hardware may include radial and sectorial instruments as well as miniprobes; the latter are used through the working channels of various endoscopes, and may even enter the biliary tract (BT) in selected cases. Today, for instance, a miniprobe may be passed down a therapeutic enteroscope in complex situations to explore the BT following a Roux-en-Y intestinal procedure. The ability to take the full potential of ultrasounds to the gut wall site nearest a lesion to be assessed provides the best approach possible, that is, an intraluminal approach using endoscopic instruments.The BT may be explored with conventional abdominal ultrasounds, which represent the basic procedure and harmless initial exam for these patients. Already in this initial step whether dilating or not the intra-or extra-hepatic BT will guide a clinician's decisions, and that is why bedside sonography without delay, as suggested by Segura et al.(1), discriminates early management and in many centers guides patient admission. BT conditions involve a highly variable anatomical and morphological substrate, and their diagnosis and appropriate management are challenging: endoscopy, surgery or radiography combined with a comprehensive, mutidisciplinary approach to the underlying disease. In addition to such variation, also of interest for surgical treatment, the BT is a dynamic structure, and stones may be located at different sites or spontaneously expelled, a minor dilation may be seen when the sustaining parenchyma develops fibrosis (cirrhosis), a postural change may displace bile stones, etc. Time is highly relevant in the BT, and its correlation to clinical manifestations is vital.Regarding diagnosis for BT diseases, another non-invasive technique to consider after abdominal US in the diagnostic algorithm is magnetic resonance cholangiography (MRC), which renders a rather reliable map of the BT, although with both technical (patient movement, metallic objects, sedation needed at times) and accuracy-related issues (small stones, short stenoses). Of course, endoscopic retrograde cholangio-pancreatography (ERCP) is superior to MRC in image quality given its dynamic contrast and action on the biliary tree (for example, with Fogarty balloon filling to better delimit a proximal area), thus better detecting extravasation, fistulas, etc.; however, ERCP has non-negligible complications and should be restricted for therapy. Hence, ERCP is -except for urgent cases such as serious cholangitis, etc.-a second-line technique following high diagnostic suspicion as a result of another non-invasive technique. EUS, however, is min...

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Usefulness of endoscopic ultrasonography in the clinical suspicion of biliary disease

Cited by 7 publications

References 40 publications

Results Obtained with the Laparoscopic Approach to the Bile Duct for the Treatment of Choledocholithiasis in 101 Cases

Results Obtained with the Laparoscopic Approach to the Bile Duct for the Treatment of Choledocholithiasis in 101 Cases

Influence of delayed cholecystectomy after acute gallstone pancreatitis on recurrence. Consequences of lack of resources

The role of endoscopic ultrasonography in the biliary tract: A great friend of ERCP's

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