title: Diagnostic Value of Endoscopic Ultrasonography in Symptomatic Patients with High and Intermediate Probabilities of Common Bile Duct Stones and a Negative Computed Tomography Scan.
abstract: OBJECTIVE
  When computed tomography (CT) does not indicate choledocholithiasis in highly suspicious patients, there is no definite consensus on the subsequent modality. Endoscopic ultrasonography (EUS) indicates fewer procedure-related complications than endoscopic retrograde cholangiopancreatography (ERCP) and has a lower cost than magnetic resonance cholangiopancreatography. Therefore, we aimed to investigate the diagnostic value of EUS in patients with suspected choledocholithiasis and negative CT findings.
  
  
  METHODS
  Between March 2008 and November 2014, we retrospectively evaluated 200 patients with negative CT findings and high or intermediate probabilities of choledocholithiasis. All patients initially underwent EUS followed by ERCP as a confirmatory criterion standard. The primary outcome in these patients was the accuracy of EUS in the detection of choledocholithiasis. The secondary outcome was the clinical prediction of common bile duct (CBD) stones in this group.
  
  
  RESULTS
  EUS indicated choledocholithiasis in 165 of the 200 patients, and ERCP confirmed choledocholithiasis in 161 patients (80.5%). The accuracy of EUS in the detection of choledocholithiasis was 94.0% (sensitivity, 97.5%; specificity, 79.5%; positive predictive value, 95.2%; negative predictive value, 88.6%). A multivariate analysis demonstrated that choledocholithiasis was strongly predicted by EUS detection of choledocholithiasis, an age >55 years and a clinical diagnosis of cholangitis.
  
  
  CONCLUSIONS
  An EUS-first approach is recommended for patients with suspected CBD stones and negative CT findings.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.|Department of Internal Medicine, The Graduate School, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Tae Joo
authors.initials: TJ
authors.lastname: Jeon
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Jae Hee
authors.initials: JH
authors.lastname: Cho
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Yeon Suk
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, The Graduate School, Yonsei University College of Medicine, Seoul, Korea.|Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Si Young
authors.initials: SY
authors.lastname: Song
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Park
mesh_terms: D000368:Aged; D042883:Choledocholithiasis / Q000000981:diagnostic imaging*; D003135:Common Bile Duct / Q000000981:diagnostic imaging; D019160:Endosonography / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011336:Probability; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D063189:Symptom Assessment / Q000379:methods / Q000706:statistics & numerical data*; D014057:Tomography, X-Ray Computed
keywords: Cholangiopancreatography, endoscopic retrograde; Choledocholithiasis; Endosonography