title: Selective utilization of pre-operative endoscopic ultrasound to exclude choledocholithiasis prior to laparoscopic cholecystectomy: a retrospective study.
abstract: OBJECTIVE
  The objective of this study was to define the clinical, biochemical and ultrasonographic criteria correlating with a likelihood of a positive preoperative endoscopic ultrasound (EUS) in patients presenting with acute gallstone-related pancreatobiliary disease.
  
  
  METHODS
  All patients who underwent EUS prior to elective laparoscopic cholecystectomy were analyzed at the Gastroenterology Unit, Kaplan Medical Center, following acute admission with cholecystitis, cholelithiasis, cholangitis, acute pancreatitis and obstructive jaundice.
  
  
  RESULTS
  One hundred and seventy four patients met the inclusion criteria. EUS showed choledocholithiasis in 37 (21.3%) with 35/37 undergoing a preoperative ERCP (24/35 cases - 64.9% positive yield). Twenty seven of the positive EUS studies (73%) were performed during the acute illness, with 50 of the 137 negative studies (36.4%) performed during the acute phase of the illness (p=0.0001). On multivariate analysis, a positive EUS was more commonly found during the acute phase of the illness [OR: 3.445; 95% CI: 1.48-8.008, p=0.004] or if there was transient jaundice [OR: 1.167; 95% CI: 1.002-1.36, p=0.047].
  
  
  CONCLUSIONS
  The timing of the examination influences the detection rate of CBD stones by EUS prior to surgery although it may be appropriate to more selectively use EUS in those patients with hyperbilirubinaemia and/or where the CBD is dilated.
authors: Department of General Surgery, Kaplan Medical Center, (affiliated to the School of Medicine, Hebrew University and Hadassah, Jerusalem), Rehovot, Israel.
authors: Tali
authors: T
authors: Shapiro
authors: Ehud
authors: E
authors: Melzer
authors: Yuval
authors: Y
authors: Binder
authors: Daniel
authors: D
authors: Keter
authors: Andrew
authors: A
authors: Zbar
authors: Rafael
authors: R
authors: Miller
authors: Eli
authors: E
authors: Mavor
mesh_terms: D016009:Chi-Square Distribution; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic; D042883:Choledocholithiasis / Q000000981:diagnostic imaging*; D003135:Common Bile Duct / Q000000981:diagnostic imaging*; D017558:Elective Surgical Procedures; D019160:Endosonography; D042882:Gallstones / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007557:Israel; D016015:Logistic Models; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012189:Retrospective Studies; D013997:Time Factors