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Diagnostic Value of Endoscopic Ultrasonography in Symptomatic Patients with High and Intermediate Probabilities of Common Bile Duct Stones and a Negative Computed Tomography Scan

Authors
 Tae Joo Jeon  ;  Jae Hee Cho  ;  Yeon Suk Kim  ;  Si Young Song  ;  Ji Young Park 
Citation
 Gut and Liver, Vol.11(2) : 290-297, 2017 
Journal Title
 Gut and Liver 
ISSN
 1976-2283 
Issue Date
2017
MeSH
Aged ; Choledocholithiasis/diagnostic imaging* ; Common Bile Duct/diagnostic imaging ; Endosonography/methods ; Endosonography/statistics & numerical data* ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Probability ; Retrospective Studies ; Sensitivity and Specificity ; Symptom Assessment/methods ; Symptom Assessment/statistics & numerical data* ; Tomography, X-Ray Computed
Keywords
Cholangiopancreatography, endoscopic retrograde ; Choledocholithiasis ; Endosonography
Abstract
Background/Aims: 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.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/161163
DOI
10.5009/gnl16052
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
Yonsei Authors
송시영(Song, Si Young)
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