EUS Versus MRCP for Patients With Intermediate Likelihood of Choledocholithiasis: A Randomized Controlled Trial

Aims In patients with an intermediate likelihood group of choledocholithiasis, ESGE guidelines recommend either EUS or MRCP to diagnose choledocholithiasis. There is no randomized control trial conducted to compare EUS and MRCP for diagnosing choledocholithiasis in these patients. We aimed to compare EUS and MRCP for the diagnosis of choledocholithiasis in patients with the intermediate likelihood of choledocholithiasis.

Methods Patients with suspected choledocholithiasis satisfying ESGE risk stratification of intermediate likelihood were screened for this single-center randomized controlled study between November 2019 to May 2020. Patients with previous pancreatobiliary and gastric surgery, acute pancreatitis, biliary stricture or malformations, underlying liver diseases, previous ERCP were excluded. The enrolled patients were randomized to either EUS or MRCP. ERCP or 3 months follow up considered as a standard reference. The diagnostic performance of EUS and MRCP was compared (NCT04173624).

Results Of 266 patients screened, 224 patients (mean age 46.77(14.57), 49.11 % female) were enrolled. The overall prevalence of choledocholithiasis was 49.55 % (111/224). The sensitivity of EUS and MRCP were 95.65 % (95 %CI 85.16 % - 99.47 %) and 92.31 % (95 % CI 82.95 % - 97.46 %) respectively and specificity of EUS and MRCP were 98.48 % (95 % CI 91.84 % to 99.96 %) and 95.74 % (95 % CI 85.46 % to 99.48 %) respectively. There was no significant difference in sensitivity (p 0.697) and specificity (p 0.569) between EUS and MRCP.

Parameter	Sensitivity	Specificity	Positive predictive value	Negative Predictive Value	Accuracy
EUS	95.65 (85.16 - 99.47)	98.48 (91.84 - 99.96)	97.78 (86.27 - 99.68)	97.01 (89.34 - 99.21)	97.32 (92.37 - 99.44)
MRCP	92.31 (82.95 - 97.46)	95.74 (85.46 - 99.48)	96.77 (88.53 - 99.15)	90.00 (79.46 - 95.44)	93.75 (87.55 - 97.45)

Conclusions The sensitivity and specificity of both EUS and MRCP are comparable for detecting choledocholithiasis in the intermediate-risk group of choledocholithiasis and the choice of a test should be based on local expertise, availability of resources, and patient preference.

Citation Jagtap N, Kumar JK, Lakhtakia S et al. eP388 EUS VERSUS MRCP FOR PATIENTS WITH INTERMEDIATE LIKELIHOOD OF CHOLEDOCHOLITHIASIS: A RANDOMIZED CONTROLLED TRIAL. Endoscopy 2021; 53: S223.

Publication History

Article published online:
19 March 2021