title: Endoscopic ultrasonography immediately prior to laparoscopic cholecystectomy: a prospective evaluation.
abstract: OBJECTIVE
  In patients who are highly likely to have common bile duct (CBD) stones, it seems necessary to image the biliary tract before laparoscopic cholecystectomy, and endoscopic ultrasonography (EUS) is one way of doing this. The aim of this study was to compare immediate preoperative EUS to intraoperative cholangiography for imaging the CBD and for the diagnosis of CBD stones, in a population with a high risk of choledocholithiasis (as assessed by clinical, biochemical, and ultrasound criteria).
  
  
  METHODS
  From January 1993 to August 1995, EUS was carried out in the operating room in 50 patients (11 men, 39 women; mean age 57 years) before laparoscopic cholecystectomy for symptomatic choledocholithiasis. A diagnosis of CBD stones by EUS or intraoperative cholangiography was always confirmed by instrumental exploration. An absence of stones in the CBD was established by a negative EUS and intraoperative cholangiography, as well as normal findings at clinical monitoring three months after laparoscopic cholecystectomy.
  
  
  RESULTS
  EUS visualized the CBD in 100% of cases. Intraoperative cholangiography was successful in 94% of cases (n = 47 of 50), and after conversion to open laparotomy in eight patients. CBD stones were found in 12 patients (24%). The sensitivity, specificity, and positive and negative predictive values for EUS were 100%, 97%, 92%, and 100%, respectively.
  
  
  CONCLUSIONS
  Immediate preoperative EUS may make it possible to select the best form of treatment in patients with CBD stones, avoiding inappropriate laparoscopic instrumental CBD exploration.
authors.affiliation: Dept. of Gastroenterology, Broussais Hospital, Paris, France.
authors.forename: J M
authors.initials: JM
authors.lastname: Aubertin
authors.forename: D
authors.initials: D
authors.lastname: Levoir
authors.forename: J L
authors.initials: JL
authors.lastname: Bouillot
authors.forename: H
authors.initials: H
authors.lastname: Becheur
authors.forename: F
authors.initials: F
authors.lastname: Bloch
authors.forename: K
authors.initials: K
authors.lastname: Aouad
authors.forename: J H
authors.initials: JH
authors.lastname: Alexandre
authors.forename: J P
authors.initials: JP
authors.lastname: Petite
mesh_terms: D002758:Cholangiography; D017081:Cholecystectomy, Laparoscopic; D019160:Endosonography; D005260:Female; D042882:Gallstones / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity