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Jacob JS, Lee ME, Chew EY, Thrift AP, Sealock RJ. Evaluating the Revised American Society for Gastrointestinal Endoscopy Guidelines for Common Bile Duct Stone Diagnosis. Clin Endosc 2020; 54:269-274. [PMID: 33153247 PMCID: PMC8039731 DOI: 10.5946/ce.2020.100] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/10/2020] [Indexed: 01/21/2023] Open
Abstract
Background/Aims The American Society for Gastrointestinal Endoscopy (ASGE) revised its guidelines for risk stratification of patients with suspected choledocholithiasis. This study aimed to assess the diagnostic performance of the revision and to compare it to the previous guidelines.
Methods We conducted a retrospective cohort study of 267 patients with suspected choledocholithiasis. We identified high-risk patients according to the original and revised guidelines and examined the diagnostic accuracy of both guidelines. We measured the association between individual criteria and choledocholithiasis. Results Under the original guidelines, 165 (62%) patients met the criteria for high risk, of whom 79% had confirmed choledocholithiasis. The categorization had a sensitivity and specificity of 68% and 55%, respectively, for the detection of choledocholithiasis. Under the revised guidelines, 86 (32%) patients met the criteria for high risk, of whom 83% had choledocholithiasis. The revised categorization had a lower sensitivity and higher specificity of 37% and 80%, respectively. The positive predictive value of the high-risk categorization increased with the revision, reflecting a potential decrease in diagnostic endoscopic retrograde cholangiopancreatograpies (ERCPs). Stone visualized on imaging had the greatest specificity for choledocholithiasis. Gallstone pancreatitis was not associated with the risk for choledocholithiasis.
Conclusions The 2019 revision of the ASGE guidelines decreases the utilization of ERCP as a diagnostic modality and offers an improved risk stratification tool.
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Affiliation(s)
- Jake S Jacob
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Michelle E Lee
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Erin Y Chew
- Department of Internal Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Aaron P Thrift
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Robert J Sealock
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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Azab M, Bharadwaj S, Jayaraj M, Hong AS, Solaimani P, Mubder M, Yeom H, Yoo JW, Volk ML. Safety of endoscopic retrograde cholangiopancreatography (ERCP) in pregnancy: A systematic review and meta-analysis. Saudi J Gastroenterol 2019; 25:341-354. [PMID: 31744939 PMCID: PMC6941455 DOI: 10.4103/sjg.sjg_92_19] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND/AIMS Endoscopic retrograde cholangiopancreatography (ERCP) is a technically challenging procedure rarely associated with severe postprocedure complications. Hormonal changes during pregnancy promote cholelithiasis, but there are limited clinical data available on the outcomes of ERCP in pregnant women. ERCP techniques without irradiation were recently introduced as potential alternative. We performed a systematic review and meta-analysis to assess the safety of ERCP in pregnancy and to compare outcomes of radiation versus nonradiation ERCP. MATERIALS AND METHODS A systematic search of PubMed, Medline/Ovid, Web of Science, and Google Scholar through April 18th, 2018 using PRISMA and MOOSE guidelines identified 27 studies reporting the outcomes of ERCP in pregnancy. Random effects pooled event rate and 95% confidence intervals (CIs) were estimated. Heterogeneity was measured by I2, and meta-regression analysis was conducted. Adverse outcomes were divided into fetal, maternal pregnancy-related, and maternal nonpregnancy-related. RESULTS In all, 27 studies reporting on 1,307 pregnant patients who underwent ERCP were identified. Median age was 27.1 years. All results were statistically significant (P < 0.01). The pooled event rate for overall adverse outcomes was 15.9% (95% CI = 0.132-0.191) in all studies combined, 17.6% (95% CI = 0.109-0.272) in nonradiation ERCP (NR-ERCP) subgroup and 21.6% (95% CI = 0.154-0.294) in radiation ERCP subgroup. There was no significant difference in the pooled event rate for fetal adverse outcomes in NR-ERCP 6.2% (95% CI = 0.027-0.137) versus 5.2% (95% CI = 0.026-0.101) in radiation ERCP group. There was no significant difference in maternal pregnancy-related adverse outcome event rate between NR-ERCP (8.4%) (95% CI = 0.038-0.173) and radiation ERCP (7.1%) (95% CI = 0.039-0.125). Maternal nonpregnancy-related adverse outcome event rate in NR-ERCP was 7.6% (95% CI = 0.038-0.145), which was half the event rate in radiation ERCP group of 14.9% (95% CI = 0.102-0.211). CONCLUSIONS ERCP done by experienced endoscopists is a safe procedure during pregnancy. Radiation-free techniques appear to reduce the rates of nonpregnancy-related complications, but not of fetal and pregnancy-related complications.
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Affiliation(s)
- Mohamed Azab
- Department of Gastroenterology and Hepatology, Loma Linda University Medical Center, California, USA,Address for correspondence: Dr. Mohamed Azab, Department of Gastroenterology, Loma Linda University School of Medicine, 11234 Anderson Street, MC 1503A, Loma Linda, California - 92354, USA. E-mail:
| | - Shishira Bharadwaj
- Department of Gastroenterology and Hepatology, Loma Linda University Medical Center, California, USA
| | - Mahendran Jayaraj
- Department of Gastroenterology, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Annie S. Hong
- Department of Internal Medicine, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Pejman Solaimani
- Department of Gastroenterology and Hepatology, Loma Linda University Medical Center, California, USA
| | - Mohamad Mubder
- Department of Internal Medicine, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Hyeyoung Yeom
- Department of School of Community Health Sciences, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Ji Won Yoo
- Department of Internal Medicine, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Michael L. Volk
- Department of Gastroenterology and Hepatology, Loma Linda University Medical Center, California, USA
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Kaif M, Agrawal D, Sreenarasimhaiah J. Can clinical factors predict the need for intervention after a positive intraoperative cholangiogram? J Dig Dis 2017; 18:410-415. [PMID: 28547873 DOI: 10.1111/1751-2980.12488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 05/20/2017] [Accepted: 05/23/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine whether clinical factors such as the elevation or decline of biochemical liver tests and bile duct dilation can help to identify patients who will truly benefit from therapeutic endoscopic retrograde cholangiopancreatography (ERCP) following a positive intraoperative cholangiography (IOC) study. METHODS All cholecystectomies during a 3-year period were examined retrospectively for positive intraoperative cholangiograms. Sonographic findings of bile duct dilation and transaminase levels at admission, including trends during the course of hospitalization and prior to ERCP, were evaluated. RESULTS Of 369 patients with intraoperative cholangiogram studies, 80 (21.7%) were positive. Prior to surgery, a sonogram showed biliary dilation in 50 (62.5%) and ERCP demonstrated actual stones in 27 (61.4%) out of 44 patients. In 24 patients with persistent elevation in transaminases and no biliary dilation, ERCP revealed stones in 12 (50.0%). Sonographic finding of biliary dilation had a positive predictive value (PPV) of 61.4% and a negative predictive value (NPV) of 60.0%. Persistent elevation in transaminases had a PPV of 59.3%. A 50% decline in transaminases had a NPV of 41.2%. Overall, only 39 (48.8%) of all patients with a positive intraoperative cholangiogram study required therapeutic ERCP. CONCLUSIONS Elevated transaminases and sonographic biliary dilation have poor predictive values for choledocholithiasis. Thus, patients with a positive intraoperative cholangiogram may benefit from additional studies, such as endoscopic ultrasound or magnetic resonance cholangiopancreatography prior to ERCP.
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Affiliation(s)
- Mohammed Kaif
- Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Deepak Agrawal
- Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jayaprakash Sreenarasimhaiah
- Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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The utility and yield of endoscopic ultrasonography for suspected choledocholithiasis in common gastroenterology practice. Eur J Gastroenterol Hepatol 2016; 28:1473-1476. [PMID: 27556688 DOI: 10.1097/meg.0000000000000733] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND STUDY AIM Endoscopic ultrasonography (EUS) is an established diagnostic modality for diagnosing common bile duct (CBD) stones. Its use has led to a reduction in the number of endoscopic retrograde cholangiopancreatography (ERCP) procedures performed for suspected choledocholithiasis. We aimed to explore the role of EUS in detecting CBD stones and/or sludge in common gastroenterology practice. PATIENTS AND METHODS We reviewed case records of 268 consecutive patients who underwent (EUS) procedures performed to confirm or rule out the presence of CBD stones and/or sludge between November 2006 and January 2011 in the Reinier de Graaf Hospital, Delft, The Netherlands, which is a nonacademic community hospital. RESULTS On the basis of EUS findings, 169 of 268 (63%) patients did not undergo ERCP and were therefore not exposed to its risk of complications. Patients with positive findings on EUS (n=99) all underwent ERCP and endoscopic sphincterotomy. Only 57 of 99 (58%) had positive findings at ERCP. The main contributing factors to this finding seem to be time interval between EUS and ERCP and the type of CBD content (i.e. sludge, one CBD stone or more than one CBD stone) described. CONCLUSION In our common gastroenterology practice, EUS plays an important role in selecting patients suspected to have CBD stones or sludge for ERCP. Much is to be learned about the probability of spontaneous passage of CBD stones and sludge into the duodenum.
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Dedemadi G, Nikolopoulos M, Kalaitzopoulos I, Sgourakis G. Management of patients after recovering from acute severe biliary pancreatitis. World J Gastroenterol 2016; 22:7708-7717. [PMID: 27678352 PMCID: PMC5016369 DOI: 10.3748/wjg.v22.i34.7708] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 06/07/2016] [Accepted: 06/15/2016] [Indexed: 02/06/2023] Open
Abstract
Cholelithiasis is the most common cause of acute pancreatitis, accounting 35%-60% of cases. Around 15%-20% of patients suffer a severe attack with high morbidity and mortality rates. As far as treatment is concerned, the optimum method of late management of patients with severe acute biliary pancreatitis is still contentious and the main question is over the correct timing of every intervention. Patients after recovering from an acute episode of severe biliary pancreatitis can be offered alternative options in their management, including cholecystectomy, endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy, or no definitive treatment. Delaying cholecystectomy until after resolution of the inflammatory process, usually not earlier than 6 wk after onset of acute pancreatitis, seems to be a safe policy. ERCP and sphincterotomy on index admission prevent recurrent episodes of pancreatitis until cholecystectomy is performed, but if used for definitive treatment, they can be a valuable tool for patients unfit for surgery. Some patients who survive severe biliary pancreatitis may develop pseudocysts or walled-off necrosis. Management of pseudocysts with minimally invasive techniques, if not therapeutic, can be used as a bridge to definitive operative treatment, which includes delayed cholecystectomy and concurrent pseudocyst drainage in some patients. A management algorithm has been developed for patients surviving severe biliary pancreatitis according to the currently published data in the literature.
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The Diagnostic Accuracy of Linear Endoscopic Ultrasound for Evaluating Symptoms Suggestive of Common Bile Duct Stones. Gastroenterol Res Pract 2016; 2016:6957235. [PMID: 27610131 PMCID: PMC5005564 DOI: 10.1155/2016/6957235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 07/13/2016] [Accepted: 07/28/2016] [Indexed: 12/23/2022] Open
Abstract
Background. In order to assess the diagnostic accuracy of linear EUS for evaluating clinically suggestive CBD stones in high-risk groups. Methods. 202 patients with clinically suggestive CBD stones in high-risk groups who underwent linear EUS examination between January 2012 and January 2015 were retrospectively reviewed. Endoscopic retrograde cholangiopancreatography (ERCP) with stone extraction or surgical choledochoscopy was only performed when a CBD stone was detected by linear EUS. Cases that were negative for CBD stones were followed up for at least 6 months. Results. Of 202 enrolled patients, 126 were positive for CBD stones according to linear EUS findings. 124 patients successfully underwent ERCP, and ERCP failed in 2 who were later successfully treated by surgical intervention. There were 2 false-positive cases with positive findings for CBD stones on ERCP. Among 76 patients without CBD stones, no false-negative cases were identified during the mean 6-month follow-up. Linear EUS had sensitivity, specificity, and positive and negative predictive values for the detection of CBD stones of 100%, 92.88%, 98.21%, and 100%, respectively. Conclusions. Linear EUS is a safe and efficacious diagnostic tool for evaluating clinically suggestive CBD stones with high risk of choledocholithiasis. Performing linear EUS prior to ERCP in patients with symptoms suggestive of CBD stones can reduce unnecessary ERCP procedures.
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Anderloni A, Repici A. Role and timing of endoscopy in acute biliary pancreatitis. World J Gastroenterol 2015; 21:11205-11208. [PMID: 26527465 PMCID: PMC4616198 DOI: 10.3748/wjg.v21.i40.11205] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 07/02/2015] [Accepted: 09/14/2015] [Indexed: 02/06/2023] Open
Abstract
The role and timing of endoscopy in the setting of acute biliary pancreatitis (ABP) is still being debated. Despite numerous randomized trials have been published, there is an obvious lack of consensus on the indications and timing of endoscopic retrograde cholangiopancreatography (ERCP) in ABP in meta-analyses and nationwide guidelines. The present editorial has been written to clarify the role of endoscopy in ABP. In clinical practice the decision to perform an ERCP is often based on biochemical and radiological criteria despite they already have been shown to be unreliable predictors of common bile duct stone presence. Endoscopic ultrasonography (EUS) is not currently a worldwide standard diagnostic procedure early in the course of acute biliary pancreatitis, but it has been shown to be accurate, safe and cost effective in diagnosing biliary obstructions compared with magnetic resonance cholangiopancreatography and ERCP and therefore in preventing unnecessary ERCP and its related complications. Early EUS in ABP allows, if appropriate, immediate endoscopic treatment and significant spare of unnecessary operative procedures thus reducing possible related complications.
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Sharma R, Menachery J, Choudhary NS, Kumar M, Puri R, Sud R. Routine endoscopic ultrasound in moderate and indeterminate risk patients of suspected choledocholithiasis to avoid unwarranted ERCP: A prospective randomized blinded study. Indian J Gastroenterol 2015; 34:300-4. [PMID: 26374752 DOI: 10.1007/s12664-015-0581-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 07/26/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Endoscopic ultrasound (EUS) is the most sensitive test for diagnosis of common bile duct stones and it may avoid unnecessary endoscopic retrograde cholangiopancreatography (ERCP). AIM The purpose of this study was to evaluate whether EUS done initially would avoid unnecessary ERCP in patients with moderate or indeterminate risk for occurrence of choledocholithiasis. METHODS Patients with biliary colic or acute biliary pancreatitis, who were referred for suspected choledocholithiasis on the basis of alterations in liver function tests were prospectively included over 12 months period in blinded randomized fashion. Endoscopic ultrasonography was performed for all patients. Patients were randomized to two groups. ERCP was done in all patients in group A irrespective of the EUS findings, while in the group B, ERCP was done only in those patients in whom EUS was suggested the presence of common bile duct stone or sludge. RESULTS A total of 50 patients were randomized into each group. EUS diagnosed common bile duct stones in 24 out of 50 patients (48 %) in group A, and ERCP identified common bile duct stones in 23 of those 24 patients. Twenty-eight out of 50 patients had common bile duct stones/sludge in group B, which were removed by subsequent ERCP. However, ERCP could be avoided in 22 cases (44 %) of group B and none of these patients had biliary symptoms up to 6 months of follow up. CONCLUSION In patients with moderate or indeterminate risk for choledocholithiasis, prior EUS done for confirmation of choledocholithiasis avoids unnecessary ERCP in almost half of the cases.
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Affiliation(s)
- Rajesh Sharma
- Department of Gastroenterology, Indira Gandhi Medical College, Circular Road, Lakkar Bazar, Shimla, 171 001, India.,Institute of Digestive and Hepatobiliary Sciences, Medanta-The Medicity, Sector 38, CH Bakhtawar Singh Road, Islampur Colony, Near Rajiv Chowk, Gurgaon, 122 001, India
| | - John Menachery
- Department of Gastroenterology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Narendra S Choudhary
- Department of Gastroenterology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Mandhir Kumar
- Department of Gastroenterology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Rajesh Puri
- Department of Gastroenterology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India.
| | - Randhir Sud
- Department of Gastroenterology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
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Wu W, Faigel DO, Sun G, Yang Y. Non-radiation endoscopic retrograde cholangiopancreatography in the management of choledocholithiasis during pregnancy. Dig Endosc 2014; 26:691-700. [PMID: 24861135 DOI: 10.1111/den.12307] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 04/07/2014] [Indexed: 12/19/2022]
Abstract
Gallstone diseases are common during pregnancy. In most cases, patients are asymptomatic and do not require any treatment. However, choledocholithiasis, cholangitis, and gallstone pancreatitis may potentially become life-threatening for both mother and fetus and often require urgent intervention. Although endoscopic retrograde cholangiopancreatography (ERCP) has become the standard technique for removing common bile duct stones, it is associated with ionizing radiation that could carry teratogenic risk. Non-radiation ERCP (NR-ERCP) is reported to be effective without incurring this risk. Two techniques have been described to confirm bile duct cannulation: bile aspiration and image guidance. With bile aspiration, biliary cannulation is confirmed by applying suction to the cannula to yield bile, thus confirming an intrabiliary position. Image guidance involves using ultrasound or direct visualization (choledochoscopy) to confirm selective biliary cannulation or duct clearance. Once cannulation is achieved, the stones are removed using standard ERCP techniques and tools. Case series and retrospective studies have reported success rates of up to 90% for NR-ERCP with complication rates similar to standard ERCP. Pregnancy outcomes are not adversely affected by NR-ERCP, but whether the avoidance of radiation carries benefit for the baby is unknown. Prospective comparative trials are lacking. NR-ERCP is technically demanding and should be attempted only by skilled biliary endoscopists in properly equipped and staffed health-care institutions, in a multidisciplinary setting.
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Affiliation(s)
- Wenming Wu
- Institute of Digestive Diseases, Chinese PLA General Hospital, Beijing, China; Department of Gastroenterology and Hepatology, General Hospital of Ji'nan Military Command Region, Ji'nan, China
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Anderloni A, Ballarè M, Pagliarulo M, Conte D, Galeazzi M, Orsello M, Andorno S, Del Piano M. Prospective evaluation of early endoscopic ultrasonography for triage in suspected choledocholithiasis: results from a large single centre series. Dig Liver Dis 2014; 46:335-9. [PMID: 24380748 DOI: 10.1016/j.dld.2013.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 10/21/2013] [Accepted: 11/14/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Endoscopic ultrasonography is accurate, safe, and cost-effective in diagnosing common bile duct stones, thus suggesting the possibility to avoid invasive endoscopic retrograde cholangiopancreatography. AIM To prospectively evaluate the diagnostic and therapeutic performance of early endoscopic ultrasonography in suspected choledocholithiasis. PATIENTS AND METHODS All consecutive patients presenting to the Emergency Department with suspicion of choledocholithiasis between January 2010 and January 2012 were evaluated and categorized as low, moderate, or high probability of choledocholithiasis, according to accepted criteria. Endoscopic endosonography was carried out within 48 h from the admission and endoscopic retrograde cholangiopancreatography was performed soon in case of confirmed choledocholithiasis. RESULTS Overall 179 patients were included: 48 (26.8%) were classified as low, 65 (36.3%) as moderate, and 66 (36.9%) as high probability of choledocholithiasis. Of the 86 patients with common bile duct stones at endoscopic endosonography, endoscopic retrograde cholangiopancreatography confirmed the finding in 79 (92%). By multivariate analysis only the common bile duct diameter proved an independent predictor of common bile duct stones. CONCLUSIONS Early endoscopic endosonography is accurate in identifying choledocholithiasis allowing immediate endoscopic treatment and significant spare of unnecessary endoscopic retrograde cholangiopancreatography. This approach can be useful as a triage test to select patients not needing endoscopic retrograde cholangiopancreatography, allowing, in selected cases, their early discharge.
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Affiliation(s)
- Andrea Anderloni
- Gastrointestinal and Digestive Endoscopy Unit, AOU "Maggiore della carità", Novara, Italy.
| | - Marco Ballarè
- Gastrointestinal and Digestive Endoscopy Unit, AOU "Maggiore della carità", Novara, Italy
| | - Michela Pagliarulo
- Gastrointestinal and Digestive Endoscopy Unit, AOU "Maggiore della carità", Novara, Italy
| | - Dario Conte
- Gastrointestinal Unit 2, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico and University of Milan, Milan, Italy
| | - Marianna Galeazzi
- Gastrointestinal and Digestive Endoscopy Unit, AOU "Maggiore della carità", Novara, Italy
| | - Marco Orsello
- Gastrointestinal and Digestive Endoscopy Unit, AOU "Maggiore della carità", Novara, Italy
| | - Silvano Andorno
- Unit of Medical Statistics and Epidemiology, Department of Medical Sciences, University of Eastern Piedmont, Novara, Italy
| | - Mario Del Piano
- Gastrointestinal and Digestive Endoscopy Unit, AOU "Maggiore della carità", Novara, Italy
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Petrov MS, Savides TJ. Systematic review of endoscopic ultrasonography versus endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis. Br J Surg 2009; 96:967-74. [PMID: 19644975 DOI: 10.1002/bjs.6667] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Endoscopic ultrasonography (EUS) has emerged as an accurate diagnostic alternative to endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to perform a systematic review of all randomized controlled trials of EUS-guided ERCP versus ERCP alone in patients with suspected choledocholithiasis. METHODS The search for eligible studies was carried out using the MEDLINE, Cochrane Central Register of Controlled Trials, and Science Citation Index electronic databases. Meta-analysis was conducted using a random-effects model. RESULTS Four trials containing 213 patients randomized to EUS-guided ERCP and 210 to ERCP alone were selected. In the EUS-guided ERCP group, ERCP was avoided in 143 patients (67.1 per cent) when EUS did not detect choledocholithiasis. The use of EUS significantly reduced the risk of overall complications (relative risk 0.35 (95 per cent confidence interval (c.i.) 0.20 to 0.62); P < 0.001) and post-ERCP acute pancreatitis (relative risk 0.21 (95 per cent c.i. 0.06 to 0.83); P = 0.030). CONCLUSION By performing EUS first, ERCP may be safely avoided in two-thirds of patients with common bile duct stones. Application of EUS in the selection of patients for therapeutic ERCP significantly reduces the complication rate.
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Affiliation(s)
- M S Petrov
- Department of Surgery, University of Auckland, Auckland, New Zealand.
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Abstract
PURPOSE OF REVIEW The present review highlights recent advances in the field of endoscopic ultrasound, which occurred in 2008 and early 2009. RECENT FINDINGS Attention will be given toward the use of endoscopic ultrasound in the diagnosis and staging of esophageal and pancreatic cancer, in the evaluation of pancreatic cysts and choledocholithiasis, and in performing therapeutic procedures such as endoscopic pseudocyst drainage and fine needle injection to treat pancreatic malignancy. SUMMARY Endoscopic ultrasound continues to be refined as a diagnostic procedure and is now emerging as a very promising and important tool for therapeutic interventions.
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Fabbri C, Polifemo AM, Luigiano C, Cennamo V, Fuccio L, Billi P, Maimone A, Ghersi S, Macchia S, Mwangemi C, Consolo P, Zirilli A, Eusebi LH, D'Imperio N. Single session versus separate session endoscopic ultrasonography plus endoscopic retrograde cholangiography in patients with low to moderate risk for choledocholithiasis. J Gastroenterol Hepatol 2009; 24:1107-12. [PMID: 19638088 DOI: 10.1111/j.1440-1746.2009.05828.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIM Endoscopic ultrasonography (EUS) is a minimally invasive diagnostic tool for common bile duct stones (CBDS) and may be used to select patients for therapeutic endoscopic retrograde cholangiography (ERC). The aim of this trial is to compare, in patients with non-high-risk for CDBS, the clinical and economic impact of EUS plus ERC performed in a single endoscopic session versus EUS plus ERC in two separate sessions. METHODS During an 11-month period, all adult patients admitted to the emergency department with suspicion of CBDS were categorized into either high-risk or non-high-risk groups, on the basis of clinical, biochemical, or transabdominal ultrasound findings. Patients in the non-high-risk group were randomized to receive EUS plus ERC in one single or in two separate sessions. RESULTS Eighty patients were recruited and randomized. Forty patients underwent EUS plus ERC in a single session and 40 patients underwent EUS plus ERC in two separate sessions. Negative EUS examination for CBDS avoided unnecessary ERC to 33 patients. Out of 47 patients with positive EUS (25 from the single session group and 22 from the double session), ERC confirmed the presence of CBDS in 46 cases (EUS sensitivity 100% and specificity 98%). Average time of procedure and hospitalization were significantly shorter in the single session group compared to the two session group. The single session strategy was also less expensive. CONCLUSION Endoscopic ultrasonography plus ERC with sphincterotomy and stone extraction performed during the same endoscopic session was safe and efficacious with a reduction of procedure time, hospitalization and costs.
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Affiliation(s)
- Carlo Fabbri
- Gastrointestinal and Endoscopy Unit, AUSL Bologna Bellaria-Maggiore Hospital, Bologna, Italy
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Sawhney R, Speer T. Patients with a high probability of choledocholithiasis are best managed with ERCP without EUS. Gastrointest Endosc 2009; 69:982-3. [PMID: 19327495 DOI: 10.1016/j.gie.2008.07.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Accepted: 07/30/2008] [Indexed: 12/10/2022]
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Acute Biliary Pancreatitis Without Cholangitis: The Growing Role of EUS. Ann Surg 2008. [DOI: 10.1097/sla.0b013e318182556d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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