title: Initial experience of direct-to-test endoscopic ultrasonography for suspected choledocholithiasis.
abstract: OBJECTIVE
  Endoscopic ultrasound has become an invaluable tool in the investigation of patients with suspected pancreatobiliary disease. We set out to determine whether a "direct-to-test" endoscopic ultrasound procedure could be offered to selected patients with suspected choledocholithiasis.
  
  
  RESULTS
  We included patients referred to our general gastroenterology service with clinical history, symptomatology and/or laboratory results compatible with choledocholithiais. Almost all patients had already had a transabdominal ultrasound performed at the request of their general practitioner. All patients underwent direct-to-test day-case endoscopic ultrasound under conscious sedation. Procedures were performed by a single practitioner using an oblique-viewing radial echoendoscope. The diagnostic yield and frequencies of discharge, onward referral and follow-up were determined. Overall diagnostic yield of direct-to-test endoscopic ultrasound was 61%. The most common diagnoses were cholelithiasis (18%) and choledocholithiasis (11%); one periampullary cancer was also detected. A definitive outcome (discharge or referral for a therapeutic procedure) occurred in 14 of 28 patients (50%). The remaining 14 patients underwent further out-patient evaluation. Eventual diagnoses in this group included autoimmune hepatitis, primary biliary cirrhosis and drug-induced hepatitis.
  
  
  CONCLUSIONS
  For patients with suspected biliary disease, direct-to-test endoscopic ultrasound has a high diagnostic yield, and may be an appropriate mode of investigation.
authors: Clinical Lecturer, Gastrointestinal Research Group, Institute of Medical Sciences, University of Aberdeen, UK; Gastrointestinal and Liver Service, Aberdeen Royal Infirmary, UK.
authors: Paul
authors: P
authors: Lochhead
authors: Consultant Gastroenterologist, Gastrointestinal and Liver Service, Aberdeen Royal Infirmary, UK p.phull@nhs.net.
authors: Perminder
authors: P
authors: Phull
mesh_terms: D015746:Abdominal Pain / Q000209:etiology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D042883:Choledocholithiasis / Q000150:complications* / Q000000981:diagnostic imaging*; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012017:Referral and Consultation; D012189:Retrospective Studies
keywords: Endosonography; biliary tract; gallbladder diseases; referral and consultation