Combined endoscopic ultrasound and stimulated biliary drainage in cholecystitis and microlithiasis--diagnoses and outcomes.
OBJECTIVE
It is becoming increasingly evident from a number of studies that endoscopic ultrasound (EUS) is much more sensitive in the diagnosis of cholecystitis than transabdominal ultrasound (TUS). The present study was undertaken to further evaluate this relative sensitivity.


METHODS
Sixty-six patients with biliary-type pain and a negative transabdominal ultrasound examination underwent combined endoscopic ultrasound and stimulated biliary drainage (EUS/SBD). Stimulated biliary drainage was obtained following intraduodenal infusion of magnesium sulfate or intravenous sincalide, a CCK analogue. EUS was considered positive if sludge or small stones were seen in the gallbladder. Stimulated biliary drainage was considered positive if calcium bilirubinate granules or cholesterol crystals were seen on microscopic examination of aspirated bile.


RESULTS
At operation, 61 of the patients had cholecystitis documented histologically. Fifty-eight of the patients had gallbladder sludge or small stones on EUS. One patient had a negative EUS, but had calcium bilirubinate granules in the bile. Twenty-one patients were followed post-operatively for a period of seven to 17 months, with an average of 10.5 months. Nineteen patients (90.5%) remain free of biliary pain.


CONCLUSIONS
Combined endoscopic ultrasound and stimulated biliary drainage (EUS/SBD) had a high sensitivity of 92.4% and a positive predictive value of 100% in the diagnosis of cholecystitis when transabdominal ultrasound was negative. A significant majority (90.5%) of patients with positive EUS/SBD who underwent cholecystectomy had resolution of their biliary pain.
Dill
J E
JE
Endoscopic Ultrasound of Virginia, Roanoke Gastroenterology, USA.
Hill
S
S
Callis
J
J
Berkhouse
L
L
Evans
P
P
Martin
D
D
Palmer
S T
ST
D002400:Cathartics; D002763:Cholecystectomy; D002764:Cholecystitis / Q000000981:diagnostic imaging* / Q000601:surgery; D002769:Cholelithiasis / Q000000981:diagnostic imaging* / Q000601:surgery; D003937:Diagnosis, Differential; D004384:Duodenoscopy; D005500:Follow-Up Studies; D016473:Gallbladder Emptying / Q000187:drug effects*; D005765:Gastrointestinal Agents; D006801:Humans; D008278:Magnesium Sulfate; D012680:Sensitivity and Specificity; D012844:Sincalide; D016896:Treatment Outcome; D014463:Ultrasonography
D002400:Cathartics; D005765:Gastrointestinal Agents; D008278:Magnesium Sulfate; D012844:Sincalide