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
-
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
-
3
Crump C.
The incidence of gallstones and gallbladder disease.
Surg Gynecol Obstet.
1931;
53
447-457
-
4
Lieber M M.
Incidence of gallstones and their correlation to other diseases.
Ann Surg.
1952;
135
394-405
-
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
-
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
-
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
-
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
-
9
Pitt H A.
Role of open choledochotomy in the treatment of choledocholithiasis.
Am J Surg.
1993;
165
483-486
-
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
-
11
Vilmann P.
Endoscopic ultrasonography-guided fine-needle aspiration biopsy of lymph nodes.
Gastrointest Endosc.
1996;
43
24-29
-
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
-
13
Amouyal P, Amouyal G, Levy P. et al .
Diagnosis of choledocholithiasis by endoscopic ultrasonography.
Gastroenterology.
1994;
106
1062-1067
-
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
-
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
-
16
Edmuntowicz S, Aliperti G, Middleton W.
Preliminary experience using endoscopic ultrasonography in the diagnosis of choledocholithiasis.
Endoscopy.
1992;
24
774-778
-
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
-
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
-
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
-
20
Suguiyama M, Atomi Y.
Endoscopic ultrasonography for diagnosing choleodocholithiasis: a prospective comparative study with ultrasonography and tomography.
Gastrointest Endosc.
1997;
45
143-146
-
21
Lachter J, Rubin A, Shiller M. et al .
Linear EUS for bile duct stones.
Gastrointest Endosc.
2000;
51
51-54
-
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
-
23
Agarwal N, Pitchumoni C S, Sivaprasad A V.
Evaluating tests for acute pancreatitis.
Am J Gastroenterol.
1990;
85
356-366
-
24 Armitage P. Metody statystyczne w badaniach medycznych. Warsaw; PZWL 1978
-
25 Brown R A, Swanson Beck J. Medical statistics on microcomputers. London; BMJ Publishing 1992
-
26
Polkowski M.
Rola ultrasonografii endoskopowej w diagnostyce kamicy żółciowej przewodowej.
Gastroenterol Pol.
1997;
5
523-528
-
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
-
28
Palazzo L.
Which test for common bile duct stones? Endoscopic and intraductal ultrasonography.
Endoscopy.
1997;
29
655-665
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
