To see the diagnostic yield of EUS prior to ERCP for patients with dilated CBD and other inconclusive imaging studies with normal or borderline derangement of LFT

Aims To see the diagnostic yield of EUS prior to ERCP for patients with dilated CBD and other inconclusive imaging studies with normal or borderline derangement of LFT.

Methods A retrospective analysis of 900 patients, referred for ERCP in last 6 years with inconclusive imaging study for dilated CBD and normal to borderline LFT derangement. The diagnostic yield of EUS prior to ERCP was measured. The feasibility and outcome of combined EUS-ERCP was recorded.

Results EUS was able to diagnose the cause of CBD dilatation in all case- Diagnostic yield-100%. 600 patients (66.67%) underwent ERCP procedure and 300 patients (33.33%) had avoided unnecessary ERCP.

Conclusions Dilated CBD on non-invasive imaging with normal or borderline derangement of LFT and unremarkable physical signs has been always a diagnostic dilemma.

In the clinical setting, however, to determine the presence of ductal calculi remains a significant dilemma; a balance must be struck between invasive ERCP, associated complications and potential inaccurate diagnosis. [1] [2]

EUS has remarkable diagnostic yield in detecting etiology of dilated CBD and avoids unnecessary ERCP’s in patients with unidentified cause on Ultrasound, CT scan or MRCP.

Combined EUS-ERCP is feasible, cost effective and can diagnose the cause of dilated CBD with inconclusive other imaging modalities accurately and thus can avoid unnecessary ERCPs.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

• References

• 1 De Angelis C, Marietti M, Bruno M, Pellicano R, Rizzetto M.. Endoscopic ultrasound in common bile duct dilatation with normal liver enzymes. World J Gastrointest Endosc 2015; 7 (08) 799-805
• 2 Netinatsunton N, Attasaranya S, Sottisuporn J, Witeerungrot T, Jongboonyanuparp T, Piratvisuth T. et al. Comparing cost-effectiveness between endoscopic ultrasound and endoscopic retrograde cholangiopancreatography in diagnosis of common bile duct stone in patients with predefined risks: A study from a developing country. Endosc Ultrasound 2016; 5: 165-72

Publication History

Article published online:
15 April 2024