Is endoscopic ultrasound needed as an add-on test for gallstone diseases without choledocholithiasis on multidetector computed tomography?
BACKGROUND
Choledocholithiasis commonly occurs in patients with symptomatic cholelithiasis. Although the recently developed multidetector computed tomography (MDCT) scan enhances the ability to diagnose choledocholithiasis, this technique is considered to have some limitations for evaluating the common bile duct (CBD).


OBJECTIVE
The purpose of this study was to evaluate the necessity for performing endoscopic ultrasound (EUS) as an add-on test to detect choledocholithiasis in patients who were diagnosed with gallstone disease without choledocholithiasis based on MDCT.


METHODS
Three hundred twenty patients with gallstone disease and no evidence of CBD stones according to MDCT underwent EUS between March 2006 and April 2011. If CBD stones were suspected based on the EUS results or clinical symptoms, a final diagnosis was obtained by endoscopic retrograde cholangiopancreatography (ERCP). The patients' medical records were retrospectively analyzed based on clinical symptoms, biochemical findings, and results of the imaging studies.


RESULTS
CBD stones were not detected with MDCT in 41 (12.8 %) out of 320 patients with gallstone disease. The causes for these discrepancies could be attributed to small stone size (n = 19, 46.3 %), isodensity (n = 18, 43.9 %), impacted stones (n = 1, 2.4 %), and misdiagnosis (n = 3, 7.3 %). If EUS were used as a triage tool, unnecessary diagnostic ERCP and its complications could be avoided for 245 (76.6 %) patients.


CONCLUSIONS
MDCT may not be a primary technique for detecting CBD stones. EUS should be performed instead as an add-on test to evaluate the CBD for patients with gallstone-related disease. In particular, EUS should be routinely recommended for patients with abnormal liver enzyme levels, pancreatitis, and dilated CBD.
Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, South Korea. bangbu@inha.ac.kr
Byoung Wook
BW
Bang
Ji Taek
JT
Hong
Young Chul
YC
Choi
Seok
S
Jeong
Don Haeng
DH
Lee
Hyung Kil
HK
Kim
Shin Goo
SG
Park
Yong Sun
YS
Jeon
D000328:Adult; D000368:Aged; D042883:Choledocholithiasis / Q000175:diagnosis* / Q000473:pathology; D019160:Endosonography; D005260:Female; D042882:Gallstones / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed