title: Endosonography For Right-sided and Acute Upper Intestinal Misery: the EFRAIM study: A prospective, randomized, controlled, blinded study.
abstract: BACKGROUND
  Acute upper abdominal pain is a frequent symptom leading to hospital admission.
  
  
  OBJECTIVE
  To determine whether a primary intra- and extraluminal diagnostic approach enabled by endoscopic ultrasound is as effective as a conventional diagnostic algorithm of transabdominal ultrasound followed by oesophagogastroduodenoscopy.
  
  
  METHODS
  A total of 240 patients who presented with acute right-sided and/or upper abdominal pain were prospectively recruited. Exclusion criteria were chronic pain, malignancy, prior abdominal surgery, bleeding, peritonitis, and elevated liver enzymes or lipase as defined 3-times higher than upper reference value. All patients underwent first transabdominal ultrasound and were then randomized (1 : 1) to either endoscopy followed by endoscopic ultrasound or vice versa. Patients and respective examiners were blinded to prior findings.
  
  
  RESULTS
  A total of 223 patients were included. Endoscopic ultrasound provided a higher diagnostic yield than the combination of transabdominal ultrasound and endoscopy (62.3 vs. 50.7%; p = 0.001). For mucosal/intraluminal lesions, we observed a very good agreement between both endoscopic modalities (kappa 0.89). The agreement for pancreatic and biliary causes was good between both ultrasound modalities (kappa 0.66).
  
  
  CONCLUSIONS
  Due to its high diagnostic yield, endoscopic ultrasound as a primary diagnostic modality appears to be a valuable option in patients with acute upper abdominal pain.
authors.affiliation: Technischen Universität München, München, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Jung
authors.affiliation: Technischen Universität München, München, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schlag
authors.affiliation: Technischen Universität München, München, Germany.
authors.forename: Valentin
authors.initials: V
authors.lastname: Becker
authors.affiliation: Technischen Universität München, München, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: von Delius
authors.affiliation: Technischen Universität München, München, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Lersch
authors.affiliation: Technischen Universität München, München, Germany.
authors.forename: Petia
authors.initials: P
authors.lastname: Jeliazkova
authors.affiliation: Technischen Universität München, München, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Herner
authors.affiliation: Technischen Universität München, München, Germany.
authors.forename: Monther
authors.initials: M
authors.lastname: Bajbouj
authors.affiliation: Technischen Universität München, München, Germany.
authors.forename: Tibor
authors.initials: T
authors.lastname: Schuster
authors.affiliation: Technischen Universität München, München, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Meining
keywords: Biliary; EUS; endoscopy; gastrointestinal; pain