Comparative evaluation of ERCP and endosonography in the diagnosis of extrahepatic biliary obstruction and a suggested algorithm.
OBJECTIVE
Endosonography is an effective diagnostic tool for evaluating pancreatobiliary diseases. However, it is scarcely used in our healthcare system because of limited resources and scarcity of trained personnel. The aim of this study was to evaluate the role of endosonography in patients presenting with extrahepatic biliary obstruction in the Indian subcontinent.


METHODS
Fifty consecutive patients presenting with suspected obstructive jaundice of unknown cause were enrolled in the study. All the patients underwent abdominal ultrasound followed by endosonography and finally endoscopic retrograde cholangiopancreatography. Final diagnosis was obtained on endoscopic retrograde cholangiopancreatography or surgery, where indicated.


RESULTS
Twenty-six patients had malignant cause for extrahepatic biliary obstruction and 24 patients had non-malignant cause for extrahepatic biliary obstruction. The etiological diagnosis was established by endosonography in 23/26 patients with malignant cause for extrahepatic biliary obstruction compared to in 21/26 patients with endoscopic retrograde cholangiopancreatography. For non-malignant cases of extrahepatic biliary obstruction, endosonography and endoscopic retrograde cholangiopancreatography were equally accurate (23/24 patients) in providing the correct etiological diagnosis.


CONCLUSIONS
Endosonography and endoscopic retrograde cholangiopancreatography are equally efficient for diagnosing the cause of extrahepatic biliary obstruction. The evaluation of patients presenting with cholestasis should be based on careful clinical judgment supported by baseline investigations to suggest likely malignant or non-malignant etiology. Endosonography as first approach should be followed in patients with suspected malignant cause of extrahepatic biliary obstruction. Endoscopic retrograde cholangiopancreatography should be performed first in patients with suspected non-malignant cause of extrahepatic biliary obstruction.
Department of Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH 43614, USA. aijaz.sofi@utoledo.edu
Aijaz A
AA
Sofi
Gul
G
Javid
Showkat
S
Zargar
Ali
A
Nawras
Malay
M
Sharma
D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D000469:Alkaline Phosphatase / Q000097:blood; D001196:Ascariasis / Q000175:diagnosis; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002769:Cholelithiasis / Q000175:diagnosis; D001651:Cholestasis, Extrahepatic / Q000209:etiology* / Q000601:surgery; D004067:Digestive System Neoplasms / Q000175:diagnosis; D019160:Endosonography; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult
D000469:Alkaline Phosphatase