title: Prospective randomized trial of EUS versus ERCP-guided common bile duct stone removal: an interim report (with video).
abstract: BACKGROUND
  EUS is being increasingly utilized for the diagnosis of choledocholithiasis and microlithiasis, especially in patients with biliary colic. Simultaneously, there is also a rising interest in the use of EUS for therapeutic interventions.
  
  
  OBJECTIVE
  Our goal was to assess the effectiveness of EUS-directed common bile duct (CBD) stone removal to compare its safety and effectiveness with ERCP-directed intervention.
  
  
  METHODS
  Interim results of a prospective, randomized, single-center blinded clinical trial.
  
  
  METHODS
  A single tertiary care referral center.
  
  
  METHODS
  Fifty-two patients with uncomplicated CBD stones were prospectively randomized to CBD cannulation and stone removal under EUS or ERCP guidance. MAIN OUTCOME MEASUREMENTS AND INTERVENTIONS: Primary outcome measure was the rate of successful cannulation of the CBD. Secondary outcome measures included successful removal of stones and overall complication rates.
  
  
  RESULTS
  CBD cannulation followed by stone extraction was successful in 23 of 26 patients (88.5%) in the EUS group (I) versus 25 of 26 patients (96.2%) in the ERCP group (II) (95% CI, -27.65%, 9.88%). Overall, there were 3 complications in the EUS group and 4 complications in the ERCP group.
  
  
  CONCLUSIONS
  The current study is an interim report from a single center report and performed by a single operator.
  
  
  CONCLUSIONS
  Our preliminary analysis indicates that outcomes following EUS-guided CBD stone retrieval are equivalent to those following ERCP. EUS-related adverse events are similar to those following ERCP. ERCP and EUS-guided stone retrieval appears to be equally effective for therapeutic interventions of the bile duct. Additional studies are required to validate these preliminary results and to determine predictors of success of EUS-guided stone removal.
authors.affiliation: University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
authors.forename: Everson L A
authors.initials: EL
authors.lastname: Artifon
authors.forename: Atul
authors.initials: A
authors.lastname: Kumar
authors.forename: Mohamad A
authors.initials: MA
authors.lastname: Eloubeidi
authors.forename: Adrienne
authors.initials: A
authors.lastname: Chu
authors.forename: Bhawna
authors.initials: B
authors.lastname: Halwan
authors.forename: Paulo
authors.initials: P
authors.lastname: Sakai
authors.forename: Manoop S
authors.initials: MS
authors.lastname: Bhutani
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde; D042883:Choledocholithiasis / Q000628:therapy*; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies