Scripties UMCG - Rijksuniversiteit Groningen
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Routine Use of Endoscopic Ultrasound in Patients with suspected Common Bileduct Stones prevents unnecessary ERCP's

(2017) Eenkhoorn, M.S.E.

Background: Endoscopic ultrasound (EUS) has been proven safe and accurate in the diagnosis of common bile duct stones (CBDS). Routine use of EUS in the work up of CBDS can prevent unnecessary endoscopic retrograde cholangiographies (ERCPs) with its potential severe complications. Since EUS is not widely available, therapeutic strategy is often based on other clinical parameters. The aim of this retrospective study was to investigate the accuracy of EUS and its clinical impact on the use of ERCP in patients with suspected CBDS.
Methods: In a single-center observational study, all consecutive patients who underwent an ERCP and/or EUS for CBDS from 2012 until 2015 were identified. In addition, all patients with suspected CBDS who underwent EUS from 2014 until 2015 were enrolled in a database. Demographic data, clinical presentation, laboratory test results, imaging studies (abdominal ultrasound, EUS, ERCP) and clinical manifestations during follow-up were recorded and analyzed. Patients were categorized in low, intermediate and high probability of CBDS, according to the ASGE guidelines. In patients with a positive EUS, ERCP was considered the gold standard. In patients with a negative EUS, biliary events related to CBDS during one year follow-up were considered as false negative.
Results: From 2012 until 2015, the increase in EUS examinations was significantly associated with a decrease in ERCPs (P<0.001). In total, 304 patients were enrolled in the database: 41 (13%) were classified as low, 136 (45%) as intermediate and 127 (42%) as high probability for CBDS. Positive EUS findings were confirmed by ERCP in 115 out of 127 patients. From the patients with negative EUS (N=177), eleven had a biliary complication. EUS had a sensitivity of 91% and specificity of 93%. Four (10%) patients with low risk, 35 (26%) with intermediate risk and 76 (60%) with high risk had confirmed CBDS.
Conclusion: Since the introduction of EUS in our hospital, there has been a significant decrease in ERCP interventions for suspected CBDS. EUS is accurate in determining the presence or absence of CBDS. We suggest that routine use of EUS in the diagnosis of CBDS should be implemented in the Dutch guideline.

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