EUS compared with endoscopy plus transabdominal US in the initial diagnostic evaluation of patients with upper abdominal pain.
BACKGROUND
Primary upper endoscopy (EGD) and transabdominal US (TUS) are often performed in patients with upper abdominal pain.


OBJECTIVE
Primary: Determine whether the combination of EGD and EUS was equivalent to EGD plus TUS in the diagnostic evaluation of upper abdominal pain. Secondary: Compare EUS versus TUS in detecting abdominal lesions, and compare EGD by using an oblique-viewing echoendoscope versus the standard, forward-viewing endoscope in detecting mucosal lesions.


METHODS
Prospective, paired design.


METHODS
Six academic endoscopy centers.


METHODS
This study involved patients with upper abdominal pain referred for endoscopy.


METHODS
All patients had EGD, EUS, and TUS. The EGD was done using both an oblique-viewing echoendoscope and the standard, forward-viewing endoscope (randomized order) by two separate endoscopists in a blinded fashion, followed by EUS. TUS was performed within 4 weeks of EGD/EUS, also in a blinded fashion.


RESULTS
telephone interviews and chart reviews.


METHODS
Diagnose possible etiology of upper abdominal pain and detect clinically significant lesions.


RESULTS
A diagnosis of the etiology of upper abdominal pain was made in 66 of 172 patients (38%). The diagnostic rate was 42 of 66 patients (64%) for EGD plus EUS versus 41 of 66 patients (62%) for EGD plus TUS, which was statistically equivalent (McNemar test; P = .27). One hundred ninety-eight lesions were diagnosed with either EUS or TUS. EUS was superior to TUS for visualizing the pancreas (P < .0001) and for diagnosing chronic pancreatitis (P = .03). Two biliary stones were detected only by EUS. Two hundred fifty-one mucosal lesions were similarly diagnosed with EGD with either the standard, forward-viewing endoscope or the oblique-viewing echoendoscope (kappa = 0.48 [95% CI, .43-.54]). EGD with the standard, forward-viewing endoscope was preferred for biopsies.


CONCLUSIONS
No cost analysis.


CONCLUSIONS
The combination of EGD with EUS is equivalent to EGD plus TUS for diagnosing a potential etiology of upper abdominal pain. EUS is superior to TUS for detecting chronic pancreatitis. EGD combined with EUS should be considered in the first-line diagnostic evaluation of patients with upper abdominal pain.
Chang
Kenneth J
KJ
Division of Gastroenterology, Department of Medicine, H. H. Chao Comprehensive Digestive Disease Center, University of California, Irvine, Orange, California, USA.
Erickson
Richard A
RA
Chak
Amitabh
A
Lightdale
Charles
C
Chen
Yang K
YK
Binmoeller
Kenneth F
KF
Albers
Gregory C
GC
Chen
Wen-Pin
WP
McLaren
Christine E
CE
Sivak
Michael V
MV
Lee
John G
JG
Isenberg
Gerard A
GA
Wong
Richard C K
RC
D000005:Abdomen / Q000000981:diagnostic imaging*; D015746:Abdominal Pain / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019723:Endoscopes; D016145:Endoscopy, Digestive System; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D055815:Young Adult