Scripties UMCG - Rijksuniversiteit Groningen
 
English | Nederlands

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.





Gebruik a.u.b. deze link om te verwijzen naar dit document:
http://irs.ub.rug.nl/dbi/59a41f07ddcca

ID 3561
Moeder ID 3463
Volgorde Eenkhoorn, M.S.E.
Naam EenkhoornMSE
Publiceren yes
OAI-naam Student_thesis
Path root/geneeskunde/2017/EenkhoornMSE/
Gemaakt op: 2017-08-28 13:47:51
Gemodificeerd op: 2017-08-28 13:47:51
Digitaal ID 59a41f07ddcca
Afstudeerrichting opleiding/afstudeerrichting 1
Studierichting Studierichting 1
Titel Routine Use of Endoscopic Ultrasound in Patients with suspected Common Bileduct Stones prevents unnecessary ERCP's
Ruilverkeer mogelijk no
Printen in opdracht no
Aantal pagina's 33
Publicatiejaar 2017
Taal en
Engelse samenvatting 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.
Nederlandse samenvatting Achtergrond: Endo-echografie (EUS) heeft zich bewezen als een veilige en nauwkeurige diagnostische methode voor choledocholithiasis (CDL). Routinematig gebruik van EUS bij patiënten met verdenking op CDL kan onnodige endoscopisch retrograde cholangio-pancreatografieën (ERCPs) met zijn potentieel ernstige complicaties, voorkomen. Aangezien EUS niet overal beschikbaar is, wordt de therapeutische strategie vaak bepaald door andere klinische parameters. Het doel van dit retrospectieve onderzoek was om de nauwkeurigheid en klinische impact van de EUS op het gebruik van de ERCP te onderzoeken bij patiënten met verdenking op CDL.
Methode: In dit observationele onderzoek vanuit Isala werden alle patiënten, die een EUS en/of ERCP ondergingen van 2012 tot en met 2015 wegens verdenking op CDL, in het directe adherentie-gebied van Isala, geïdentificeerd. Daarnaast zijn alle patiënten die een EUS ondergingen wegens verdenking op CDL van 2014 tot en met 2015 verwerkt in een elektronische database. Demografische gegevens, klinische presentatie, laboratorium waardes, beeldvormende diagnostiek (abdominale echo, EUS en ERCP) en het klinische beloop tijdens follow-up werden verwerkt en geanalyseerd. Patiënten werden vervolgens gecategoriseerd in laag, gemiddeld en hoog risico op CDL, gebaseerd op de ASGE richtlijn. Bij patiënten met een positieve EUS werd ERCP beschouwd als de gouden standaard, voor patiënten met een negatieve EUS was dit de klinische follow-up gedurende een jaar zonder biliaire complicaties gerelateerd aan CDL.
Resultaten: Van 2012 tot en met 2015 was een toename van het aantal EUS significant geassocieerd met een daling in ERCP’s. In totaal werden er 304 patiënten geëvalueerd: 41 (13%) waren geclassificeerd als laag, 136 (45%) als gemiddeld en 127 (42%) als hoog risico op CDL. Een positieve uitslag van de EUS werd bij 115 van de 127 bevestigd middels ERCP. Van de patiënten met een negatieve EUS (N=177), hadden elf patiënten een biliaire complicatie gedurende follow-up. EUS had een sensitiviteit van 91% en een specificiteit van 93%. Bij vier (10%) patiënten met laag risico, 34 (26%) met gemiddeld risico en 76 (60%) met hoog risico bleek sprake te zijn van CDL.
Conclusie: Sinds de introductie van de EUS in ons ziekenhuis, is er een significante afname van ERCP-interventies voor verdenking op CDL. EUS identificeert veilig en met hoge nauwkeurigheid de aan- en afwezigheid van CDL. Wij stellen voor dat routinematig gebruik van de EUS bij verdenking op CDL geïmplementeerd zou moeten worden in de Nederlandse richtlijn.
Onderwijsinstelling Medical Sciences
Type embargo abstract openbaar, scriptie op aanvraag
Auteur(s) Eenkhoorn, M.S.E.
UMCG begeleider(s) Faculty supervisor:; Poen, Dr. A.C; gastroenterologist; Location: Isala Hospital, Zwolle, the Netherlands; Department: Gastroenterology and Hepatology
Auteur(s) Eenkhoorn, M.S.E.
UMCG begeleider(s) Faculty supervisor:; Poen, Dr. A.C; gastroenterologist; Location: Isala Hospital, Zwolle, the Netherlands; Department: Gastroenterology and Hepatology


 
To top