Korean J Gastroenterol.  2010 Aug;56(2):97-102. 10.4166/kjg.2010.56.2.97.

The Usefulness of Endoscopic Ultrasonography in the Diagnosis of Choledocholithiasis without Common Bile Duct Dilatation

• Lee SR
• Lee JH
• Lee SY
• Kim HH
• Park JH
• Ryu SH
• Kim YS
• Moon JS

• KMID: 1775864
• DOI: http://doi.org/10.4166/kjg.2010.56.2.97

Abstract

BACKGROUND/AIMS
Endoscopic retrograde cholangiopancreatography (ERCP) is the most accurate modality in diagnosis of choledocholithiasis. However, it carries some complications. Endoscopic ultrasonography (EUS) is less invasive than ERCP and used for the diagnosis of choledocholithiasis. Recent studies showed that a usefulness of EUS for the diagnosis of small choledocholithiasis without common bile duct (CBD) dilatation. For such a reason, ERCP is being replaced by EUS in the diagnosis of bile duct stones. The aim of this study was to investigate the accuracy of EUS for the diagnosis of choledocholithiasis without CBD dilatation.
METHODS
A total of 66 patients with suspected choledocholithiasis without CBD dilatation were enrolled. EUS were performed in all cases within 48 hours after computed tomography (CT) or ultrasonography (US). Final diagnosis was obtained by ERCP or clinical course (minimum 6 months follow-up). We analyzed the accuracy of US, CT, and EUS, respectively.
RESULTS
CT and US were performed in 51 and 15 cases, respectively. CBD stones were detected in 23 (35%) patients by ERCP. EUS showed 100% sensitivity, 95% specificity, 92% positive predictive value, and 100% negative predictive value for identifying CBD stones. CT or US showed 26%, 93%, 67%, and 70%, respectively. There were no EUS-related complications.
CONCLUSIONS
EUS was more effective than CT or US and as accurate as ERCP for the diagnosis of small choledocholithiasis without CBD dilatation. Thus, EUS may help to avoid unnecessary diagnostic ERCP and its complication.

Keyword

Choledocholithiasis; Common bile duct; Endoscopic ultrasonography

MeSH Terms

Adult
Aged
Aged, 80 and over
Choledocholithiasis/pathology/*ultrasonography
Common Bile Duct Diseases/diagnosis
Diagnosis, Differential
Dilatation, Pathologic/diagnosis
*Endosonography
Female
Gallstones/ultrasonography
Humans
Male
Middle Aged
Sensitivity and Specificity
Tomography, X-Ray Computed

Figure

• 

  Fig. 1. Abdominal computed tomography and endoscopic ultrasonography findings of common bile duct stone. (A) Abdominal computed tomography showed the common bile duct was not dilated without definite mass lesion. (B) Endoscopic ultrasonography showed a small hyperechoic foci with an acoustic shadowing in the common bile duct. The stone's size was about 5 mm. CBD, common bile duct; PV, portal vein.

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