title: Do normal findings at biliary endoscopic ultrasonography obviate the need for endoscopic retrograde cholangiography in patients with suspicion of common bile duct stone? A prospective follow-up study of 238 patients.
abstract: OBJECTIVE
  Biliary endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiography (ERC) are equally accurate for the diagnosis of common bile duct (CBD) stone. The aim of this prospective 1-year follow-up study was to determine whether normal findings at initial EUS obviated the need for ERC.
  
  
  METHODS
  During a 17-month period, all patients referred for biliary EUS because of suspicion of CBD stone, in whom EUS findings were normal were included in the study. Early (1-month) and late (1-year) follow-up details were obtained by mail or telephone. The clinical course and need for ERC were recorded.
  
  
  RESULTS
  238 patients were enrolled. During follow-up, 59 (25 %) patients underwent cholecystectomy, with (n=31) or without (n=28) cholangiography, and 30 patients underwent ERC (13 %). CBD stone was found in 14 (6 %) patients. Of these 30 patients, ERC was done in 15 cases in the first week after EUS, because of persistent suspicion of a CBD stone which was found in 10 patients. The 15 late ERC procedures (carried out more than 1 week after EUS) revealed only one CBD stone. The negative predictive value of EUS for the diagnosis of CBD stones was 95.4 %.
  
  
  CONCLUSIONS
  Patients with suspicion of CBD stones but normal EUS findings have a low risk of needing ERC in a 1-year period.
authors.affiliation: Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Lyon, France. bertrand.napoleon@libertysurf.fr
authors.forename: B
authors.initials: B
authors.lastname: Napoléon
authors.forename: J
authors.initials: J
authors.lastname: Dumortier
authors.forename: O
authors.initials: O
authors.lastname: Keriven-Souquet
authors.forename: B
authors.initials: B
authors.lastname: Pujol
authors.forename: T
authors.initials: T
authors.lastname: Ponchon
authors.forename: J-C
authors.initials: JC
authors.lastname: Souquet
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D002763:Cholecystectomy / Q000379:methods; D015331:Cohort Studies; D019160:Endosonography / Q000379:methods*; D005188:False Negative Reactions; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D017678:Sex Distribution