title: Linear echoendoscope-guided ERCP for the diagnosis of occult common bile duct stones.
abstract: BACKGROUND
  Less than 67% of patients with intermediate risk for common bile duct (CBD) stones require therapeutic intervention. It is important to have an accurate, safe, and reliable method for the definitive diagnosis of CBD stones before initiating therapeutic endoscopic retrograde cholangiopancreatography (ERCP). Few publications detail the diagnostic efficacy of linear echoendoscopy (EUS) for CBD stones.
  
  
  METHODS
  30 patients with biliary colic, pancreatitis, unexplained derangement of liver function tests, and/or dilated CBD without an identifiable cause were enrolled in the study. When a CBD stone was disclosed by linear EUS, ERCP with stone extraction was performed. Patients who failed ERCP were referred for surgical intervention. If no stone was found by EUS, ERCP would not be performed and patients were followed-up for possible biliary symptoms for up to three months.
  
  
  RESULTS
  The major reason for enrollment was acute pancreatitis. The mean predicted risk for CBD stones was 47% (28-61). Of the 12 patients who were positive for CBD stones by EUS, nine had successful ERCP, one failed ERCP (later treated successfully by surgical intervention) and two were false-positive cases. No procedure-related adverse events were noted. For those 18 patients without evidence of CBD stones by EUS, no false-negative case was noted during the three-month follow-up period. Linear EUS had sensitivity, specificity, positive and negative predicted values for the detection of CBD stones of 1, 0.9, 0.8 and 1, respectively.
  
  
  CONCLUSIONS
  Linear EUS is safe and efficacious for the diagnosis of occult CBD stones in patients with intermediate risk for the disease.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung 81362, Taiwan.
authors.forename: Hoi-Hung
authors.initials: HH
authors.lastname: Chan
authors.forename: E-Ming
authors.initials: EM
authors.lastname: Wang
authors.forename: Meng-Shun
authors.initials: MS
authors.lastname: Sun
authors.forename: Ping-I
authors.initials: PI
authors.lastname: Hsu
authors.forename: Wei-Lun
authors.initials: WL
authors.lastname: Tsai
authors.forename: Tzung-Jiun
authors.initials: TJ
authors.lastname: Tsai
authors.forename: Kai-Ming
authors.initials: KM
authors.lastname: Wang
authors.forename: Wen-Chi
authors.initials: WC
authors.lastname: Chen
authors.forename: Huay-Min
authors.initials: HM
authors.lastname: Wang
authors.forename: Huei-Lung
authors.initials: HL
authors.lastname: Liang
authors.forename: Kwok-Hung
authors.initials: KH
authors.lastname: Lai
authors.forename: William Robert
authors.initials: WR
authors.lastname: Brugge
mesh_terms: D000208:Acute Disease; D000368:Aged; D001660:Biliary Tract Diseases / Q000209:etiology; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation* / Q000379:methods*; D003085:Colic / Q000209:etiology; D005260:Female; D042882:Gallstones / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity