Endoscopic ultrasonography versus cholangiography for the diagnosis of choledocholithiasis.
BACKGROUND
Choledocholithiasis is a major source of morbidity among patients undergoing cholecystectomy for symptomatic gallstones. There is no consensus on the best approach to diagnosing bile duct stones. We compared the safety, accuracy, diagnostic yield, and cost of EUS- and ERCP-based approaches.


METHODS
Sixty-four consecutive pre- and post-cholecystectomy patients referred for endoscopic retrograde cholangiopancreatography (ERCP) for suspected choledocholithiasis were prospectively evaluated in a blinded fashion. All were stratified into risk groups using predefined criteria. Endoscopic ultrasonography (EUS) and ERCP were sequentially performed by two endoscopists.


RESULTS
The success rates of EUS and ERCP were 98% and 94%, respectively. The accuracy of EUS for diagnosing choledocholithiasis was 94%. EUS provided an additional or alternative diagnosis to bile duct stones in 21% of patients. The complication rate of EUS was significantly lower than diagnostic ERCP. An EUS-based strategy costs less than diagnostic ERCP in patients with low, moderate, or intermediate risk.


CONCLUSIONS
EUS is comparably accurate, but safer and less costly than ERCP for evaluating patients with suspected choledocholithiasis. It is useful in patients with an increased risk of having common bile duct stones based on clinical criteria and those with contraindications for or prior unsuccessful ERCP. EUS may enable selective performance of ERCP and improve the cost-effectiveness of diagnosing choledocholithiasis.
Canto
M I
MI
Department of Medicine (Gastroenterology), University Hospitals of Cleveland-Case Western Reserve University, Ohio, USA.
Chak
A
A
Stellato
T
T
Sivak
M V
MV
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000191:economics; D003365:Costs and Cost Analysis; D004311:Double-Blind Method; D019160:Endosonography / Q000009:adverse effects / Q000191:economics; D004869:Equipment Safety; D005260:Female; D042882:Gallstones / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D012680:Sensitivity and Specificity; D012984:Software; D018709:Statistics, Nonparametric; D014481:United States