[The usefulness of endoscopic ultrasonography in the diagnosis of choledocholithiasis without common bile duct dilatation].
OBJECTIVE
Endoscopic retrograde cholangiopancreatography (ERCP) is the most accurate modality in diagnosis of choledocholithiasis. However, it carries some complications. Endoscopic ultrasonography (EUS) is less invasive than ERCP and used for the diagnosis of choledocholithiasis. Recent studies showed that a usefulness of EUS for the diagnosis of small choledocholithiasis without common bile duct (CBD) dilatation. For such a reason, ERCP is being replaced by EUS in the diagnosis of bile duct stones. The aim of this study was to investigate the accuracy of EUS for the diagnosis of choledocholithiasis without CBD dilatation.


METHODS
A total of 66 patients with suspected choledocholithiasis without CBD dilatation were enrolled. EUS were performed in all cases within 48 hours after computed tomography (CT) or ultrasonography (US). Final diagnosis was obtained by ERCP or clinical course (minimum 6 months follow-up). We analyzed the accuracy of US, CT, and EUS, respectively.


RESULTS
CT and US were performed in 51 and 15 cases, respectively. CBD stones were detected in 23 (35%) patients by ERCP. EUS showed 100% sensitivity, 95% specificity, 92% positive predictive value, and 100% negative predictive value for identifying CBD stones. CT or US showed 26%, 93%, 67%, and 70%, respectively. There were no EUS-related complications.


CONCLUSIONS
EUS was more effective than CT or US and as accurate as ERCP for the diagnosis of small choledocholithiasis without CBD dilatation. Thus, EUS may help to avoid unnecessary diagnostic ERCP and its complication.
Lee
Jung Hwan
JH
Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea. jw0412@korea.com
Lee
Sang Ryul
SR
Lee
Su Yeon
SY
Kim
Hyung Hun
HH
Park
Jong Hyeok
JH
Ryu
Soo Hyung
SH
Kim
You Sun
YS
Moon
Jeong Seop
JS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D042883:Choledocholithiasis / Q000000981:diagnostic imaging* / Q000473:pathology; D003137:Common Bile Duct Diseases / Q000175:diagnosis; D003937:Diagnosis, Differential; D004108:Dilatation, Pathologic / Q000175:diagnosis; D019160:Endosonography; D005260:Female; D042882:Gallstones / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed