Role of endoscopic ultrasonography in prevention of unnecessary endoscopic retrograde cholangiopancreatography: a prospective study of 150 patients.
OBJECTIVE
The purpose of this study was to evaluate the impact of substituting endoscopic ultrasonography (EUS) for endoscopic retrograde cholangiopancreatography (ERCP) in cases of a low to intermediate risk for choledocholithiasis.


METHODS
During a 16-month period, patients who were referred for suspected choledocholithiasis, biliary colic, or acute biliary pancreatitis on the basis of alterations in liver enzyme values with or without gallstones seen on transabdominal ultrasonography were included. Endoscopic ultrasonography was performed for all patients. Patients with common bile duct stones underwent ERCP. Cholecystectomy was recommended in all patients with symptomatic gallstones. Cases were followed for 12 months.


RESULTS
A total of 150 patients were included. Choledocholithiasis was diagnosed by EUS in 39 patients (26.0%) and was confirmed by ERCP in 30 (77.0%). Fifty-one patients had a normal common bile duct, and follow-up for 12 months showed no abnormalities except in 1 patient. Cholecystectomy without ERCP was recommended for the remaining 60 patients who had symptomatic gallstones or sludge. Endoscopic retrograde cholangiopancreatography was avoided by this approach in 110 patients (73.3%).


CONCLUSIONS
In a low to intermediate risk for choledocholithiasis, EUS can preclude the need for ERCP in most cases.
Sotoudehmanesh
Rasoul
R
Digestive Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran. setoodeh@ams.ac.ir
Kolahdoozan
Shadi
S
Asgari
Ali Ali
AA
Dooghaei-Moghaddam
Masoud
M
Ainechi
Sanaz
S
D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000706:statistics & numerical data*; D002763:Cholecystectomy; D042883:Choledocholithiasis / Q000000981:diagnostic imaging*; D003135:Common Bile Duct / Q000473:pathology*; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012306:Risk; D019564:Unnecessary Procedures