Accuracy of Linear Endoscopic Ultrasonography in the Evaluation of Patients with Suspected Common Bile Duct Stones

 

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Background and Study Aims: Endoscopic ultrasonography (EUS) with radial scanning is an efficient diagnostic tool where there is suspicion of common bile duct (CBD) stones. Little is known about the use of linear EUS in this condition. The aim of this study was to evaluate the diagnostic efficiency of linear EUS in a large group of patients suspected to have bile duct stones, using endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy and exploration of the CBD using a Dormia basket, or surgical choledochotomy with choledochoscopy, as diagnostic “gold standards.”
Patients and Methods: 134 patients with clinical suspicion of CBD stones were included in the study and prospectively evaluated, using EUS, and ERCP with endoscopic sphincterotomy (127 patients), or choledochotomy with choledochoscopy where ERCP was unsuccessful (seven patients). EUS was done before ERCP using an echo endoscope (Pentax FG 32 UA; 5 - 7.5 MHz) and Hitachi EUB 405 ultrasound machine. ERCP was done using the TFJ 100 or TJ 20 Olympus duodenoscope. ERCP was carried out within a mean of 2 days after EUS. The longest time between EUS and ERCP was 3 days. The examiners were blinded to the results of the other method used.
Results: CBD stones were found in 91 (68 %) patients at ERCP with ES or at surgery. The correct diagnosis was established by EUS in 85 patients. The remaining 43 patients without CBD stones were correctly diagnosed in 41 cases by means of EUS, giving an accuracy of 94 %, sensitivity of 93 %, specificity of 93 %, a positive predictive value of 98 %, a negative predictive value of 87 %, and a Youden’s index of 89 %.
Conclusions: Linear EUS is a fairly reliable method for the evaluation of patients with high suspicion for CBD stones. The usefulness of linear EUS in the evaluation of patients with low or moderate suspicion for CBD stones warrants further study.

References

• 1 Barbara L, Sama C, Morselli-Labate A M. et al . 10-years incidence of gallstone disease: the Sirmione study.  J Hepatol. 1993;  18 S43
  PubMedGoogle Scholar
• 2 Capocaccia L, Ricci G, Angelico F. et al .Prevalence of gallstone disease in 18 Italian population samples: first results from the MICOL study. In: Capocaccia L (ed) Recent advances in the epidemiology and prevention of gallstone disease. Dordrecht; Kluwer Academic Publishers 1991: 37-44
  Google Scholar
• 3 Crump C. The incidence of gallstones and gallbladder disease.  Surg Gynecol Obstet. 1931;  53 447-457
  PubMedGoogle Scholar
• 4 Lieber M M. Incidence of gallstones and their correlation to other diseases.  Ann Surg. 1952;  135 394-405
  PubMedGoogle Scholar
• 5 Bartlett M K, Waddell W R. Indications for common bile duct exploration: evaluation in 1000 cases.  N Engl J Med. 1958;  258 164-167
  PubMedGoogle Scholar
• 6 Napoleon B, Pujal B, Pouchon T. et al . Prospective study of the accuracy of endoscopic ultrasonography for the diagnosis of bile duct stones.  Endoscopy. 1994;  26 A238
  PubMedGoogle Scholar
• 7 Hainsworth P, Rhodes M, Gomperetz R. et al . Imaging of the common bile duct in patients undergoing laparoscopic cholecystectomy.  Gut. 1994;  35 991-995
  PubMedGoogle Scholar
• 8 Koo K P, Traverso L W. Do preoperative indicators predict the presence of common bile duct stones during laparoscopic cholecystectomy?.  Am J Surg. 1997;  171 495-499
  PubMedGoogle Scholar
• 9 Pitt H A. Role of open choledochotomy in the treatment of choledocholithiasis.  Am J Surg. 1993;  165 483-486
  PubMedGoogle Scholar
• 10 Vilmann P, Hancke S, Henriksen F W, Jacobsen G K. Endoscopic ultrasonography-guided fine-needle aspiration biopsy of lesions in the upper GI tract.  Gastrointest Endosc. 1995;  41 230-235
  PubMedGoogle Scholar
• 11 Vilmann P. Endoscopic ultrasonography-guided fine-needle aspiration biopsy of lymph nodes.  Gastrointest Endosc. 1996;  43 24-29
  PubMedGoogle Scholar
• 12 Frossard J L, Sosa-Valencia L, Amouyal G. et al . Usefulness of endoscopic ultrasonography in patients with “idiopathic” acute pancreatitis.  Am J Med. 2000;  109 196-200
  CrossrefPubMedGoogle Scholar
• 13 Amouyal P, Amouyal G, Levy P. et al . Diagnosis of choledocholithiasis by endoscopic ultrasonography.  Gastroenterology. 1994;  106 1062-1067
  PubMedGoogle Scholar
• 14 Canto M, Chak A, Stellato T, Sivak M V Jr. Endoscopic ultrasonography versus cholangiography for the diagnosis of choledocholithiasis.  Gastrointest Endosc. 1998;  47 439-448
  CrossrefPubMedGoogle Scholar
• 15 Denis B, Bas V, Goudot C. et al . Accuracy of endoscopic ultrasonography in the diagnosis of common bile duct stones.  Gastroenterology. 1993;  104 A358
  PubMedGoogle Scholar
• 16 Edmuntowicz S, Aliperti G, Middleton W. Preliminary experience using endoscopic ultrasonography in the diagnosis of choledocholithiasis.  Endoscopy. 1992;  24 774-778
  PubMedGoogle Scholar
• 17 Giovannini M, Seitz J F. Endoscopic ultrasonography with linear-type echo endoscope in the evaluation of 94 patients with pancreatobiliary disease.  Endoscopy. 1994;  26 579-585
  Article in Thieme ConnectPubMedGoogle Scholar
• 18 Polkowski M, Palucki J, Regula J. et al . Helical CT cholangiography versus endosonography for suspected bile duct stones - a prospective blinded study in non-jaundiced patients.  Gut. 1999;  45 744-749
  CrossrefPubMedGoogle Scholar
• 19 Prat F, Amouyal G, Pelletier V, Fritsch J. et al . Prospective controlled study of endoscopic ultrasonography and endoscopic retrograde cholangiography in patients with suspected common bile duct lithiasis.  Lancet. 1996;  346 75-79
  PubMedGoogle Scholar
• 20 Suguiyama M, Atomi Y. Endoscopic ultrasonography for diagnosing choleodocholithiasis: a prospective comparative study with ultrasonography and tomography.  Gastrointest Endosc. 1997;  45 143-146
  PubMedGoogle Scholar
• 21 Lachter J, Rubin A, Shiller M. et al . Linear EUS for bile duct stones.  Gastrointest Endosc. 2000;  51 51-54
  CrossrefPubMedGoogle Scholar
• 22 Quirk D, Kesley P, Schapiro R, Brugge W. The use of linear-array ultrasonography in the detection of common bile duct stones.  Gastrointest Endosc. 1997;  45 AB178
  PubMedGoogle Scholar
• 23 Agarwal N, Pitchumoni C S, Sivaprasad A V. Evaluating tests for acute pancreatitis.  Am J Gastroenterol. 1990;  85 356-366
  PubMedGoogle Scholar
• 24 Armitage P. Metody statystyczne w badaniach medycznych. Warsaw; PZWL 1978
  Google Scholar
• 25 Brown R A, Swanson Beck J. Medical statistics on microcomputers. London; BMJ Publishing 1992
  Google Scholar
• 26 Polkowski M. Rola ultrasonografii endoskopowej w diagnostyce kamicy żółciowej przewodowej.  Gastroenterol Pol. 1997;  5 523-528
  PubMedGoogle Scholar
• 27 Palazzo L, Girollet P, Salmeron M. Value of endoscopic ultrasonography in the diagnosis of common bile duct stones: comparison with surgical exploration and ERCP.  Gastrointest.Endosc. 1995;  42 225-231
  PubMedGoogle Scholar
• 28 Palazzo L. Which test for common bile duct stones? Endoscopic and intraductal ultrasonography.  Endoscopy. 1997;  29 655-665
  PubMedGoogle Scholar

M. Kohut, M.D.

Department of Gastroenterology · Silesian Medical Academy

Ul. Medyków 14 · 40-752 Katowice · Poland

Fax: + 48-32-2523119

Email: Maciej.2250177@pharmanet.com.pl