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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

 Tae Joo Jeon  ;  Jae Hee Cho  ;  Yeon Suk Kim  ;  Si Young Song  ;  Ji Young Park 
 GUT AND LIVER, Vol.11(2) : 290-297, 2017 
Journal Title
Issue Date
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
Cholangiopancreatography, endoscopic retrograde ; Choledocholithiasis ; Endosonography
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.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Song, Si Young(송시영) ORCID logo https://orcid.org/0000-0002-1417-4314
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