EUS in the management of uninvestigated dyspepsia.
BACKGROUND
Management of dyspepsia often involves multiple diagnostic tests. By virtue of luminal and extraluminal imaging, EUS may be a satisfactory single test for the evaluation of patients with dyspepsia.


METHODS
Patients with uninvestigated dyspepsia of more than 4 weeks duration were recruited. All underwent transabdominal US followed by EUS and EGD to look for both luminal and extraluminal lesions that could account for the dyspeptic symptoms. Each of these studies was performed by an independent operator blinded to the results of the other examinations. Patients were followed for 1 year to monitor clinical outcome.


RESULTS
Two hundred patients were recruited. Compared with EGD, EUS had accuracies of 92% to 100% for the diagnosis of different luminal lesions. All gastric ulcers and cancers were detected by EUS, but 3 duodenal ulcers were missed. EUS also identified 48 pancreaticobiliary lesions, 23 of which were detected by US, that could account for the dyspeptic symptoms. Other extraintestinal lesions including mediastinal malignant lymphadenopathy and a dissecting aortic aneurysm were also diagnosed by EUS. Through the identification of extraluminal lesions, staging of tumors, and exclusion of pancreaticobiliary diseases, EUS altered clinical management in 50 patients (25%).


CONCLUSIONS
EUS is a useful one-step investigation in patients with dyspepsia.
Lee
Yuk Tong
YT
Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, China.
Lai
Alex C W
AC
Hui
Yui
Y
Wu
Justin C Y
JC
Leung
Vincent K S
VK
Chan
Francis K l
FK
Chung
S C Sydney
SC
Sung
Joseph J Y
JJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002769:Cholelithiasis / Q000000981:diagnostic imaging; D004066:Digestive System Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D004381:Duodenal Ulcer / Q000000981:diagnostic imaging; D004415:Dyspepsia / Q000000981:diagnostic imaging* / Q000209:etiology; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D013276:Stomach Ulcer / Q000000981:diagnostic imaging