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Mahajan A, Das K, Kishalaya, Misra D, Das K, Dhali GK. Diagnostic yield of endoscopic ultrasound in dilated common bile duct with non-diagnostic cross-sectional imaging. BMC Gastroenterol 2024; 24:309. [PMID: 39261769 PMCID: PMC11391711 DOI: 10.1186/s12876-024-03406-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 09/05/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Biliary dilatation without obvious etiology on cross sectional imaging warrants further investigation. This study aimed to assess yield of endoscopic ultrasound in providing etiologic diagnosis in such situation. METHODS Prospective cohort of consecutive patients with biliary dilatation & non diagnostic computed tomography (CT) and /or magnetic resonance imaging (MRI) underwent endoscopic ultrasound (EUS) with/without fine needle aspiration cytology (FNAC) and were followed clinically, biochemically with/without radiology for up to six months. The findings of EUS were corroborated with histopathology of surgical specimens and endoscopic retrograde cholangiography (ERCP) findings in relevant cases. RESULTS Median age of 121 patients completing follow up was 55 years. 98.2% patients were symptomatic and median common bile duct (CBD) diameter was 13 mm. EUS was able to identify lesions attributable for biliary dilatation in (67 out of 121) 55.4% cases with ampullary neoplasm being the commonest (29 out of 67 i.e. 43%). Multivariate logistic regression analysis identified jaundice as the predictor of positive diagnosis on EUS, of finding ampullary lesion and pancreatic lesion on EUS. EUS had sensitivity, specificity, positive predictive value and diagnostic accuracy of 95.65%, 94.23%, 95.65% and 95.04% respectively in providing etiologic diagnosis. Threshold value for baseline bilirubin of 10 mg%, for baseline CA 19.9 of 225 u/L and for largest CBD diameter of 16 mm were determined to have specificity of 98%, 95%, 92.5% respectively of finding a positive diagnosis on EUS. CONCLUSION EUS provides considerable diagnostic yield with high accuracy in biliary dilatation when cross sectional imaging fails to provide etiologic diagnosis.
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Affiliation(s)
- Ankit Mahajan
- Department of Gastroenterology, School of Digestive and Liver Diseases, Institute of PostGraduate Medical Education & Research, 244, A.J.C. Bose Road, Kolkata, West Bengal, PIN 700020, India
| | - Kshaunish Das
- Department of Gastroenterology, School of Digestive and Liver Diseases, Institute of PostGraduate Medical Education & Research, 244, A.J.C. Bose Road, Kolkata, West Bengal, PIN 700020, India
| | - Kishalaya
- Department of Gastroenterology, School of Digestive and Liver Diseases, Institute of PostGraduate Medical Education & Research, 244, A.J.C. Bose Road, Kolkata, West Bengal, PIN 700020, India
| | - Debashis Misra
- Department of Gastroenterology, School of Digestive and Liver Diseases, Institute of PostGraduate Medical Education & Research, 244, A.J.C. Bose Road, Kolkata, West Bengal, PIN 700020, India.
| | - Kausik Das
- Department of Hepatology, School of Digestive and Liver Diseases, Institute of PostGraduate Medical Education & Research, 244, A.J.C. Bose Road, Kolkata, West Bengal, PIN 700020, India
| | - Gopal Krishna Dhali
- Department of Gastroenterology, School of Digestive and Liver Diseases, Institute of PostGraduate Medical Education & Research, 244, A.J.C. Bose Road, Kolkata, West Bengal, PIN 700020, India
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De Angelis CG, Dall’Amico E, Staiano MT, Gesualdo M, Bruno M, Gaia S, Sacco M, Fimiano F, Mauriello A, Dibitetto S, Canalis C, Stasio RC, Caneglias A, Mediati F, Rocca R. The Endoscopic Retrograde Cholangiopancreatography and Endoscopic Ultrasound Connection: Unity Is Strength, or the Endoscopic Ultrasonography Retrograde Cholangiopancreatography Concept. Diagnostics (Basel) 2023; 13:3265. [PMID: 37892086 PMCID: PMC10606726 DOI: 10.3390/diagnostics13203265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/05/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023] Open
Abstract
Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) are both crucial for the endoscopic management of biliopancreatic diseases: the combination of their diagnostic and therapeutic potential is useful in many clinical scenarios, such as indeterminate biliary stenosis, biliary stones, chronic pancreatitis and biliary and pancreatic malignancies. This natural and evident convergence between EUS and ERCP, which by 2006 we were calling the "Endoscopic ultrasonography retrograde colangiopancreatography (EURCP) concept", has become a hot topic in the last years, together with the implementation of the therapeutic possibilities of EUS (from EUS-guided necrosectomy to gastro-entero anastomoses) and with the return of ERCP to its original diagnostic purpose thanks to ancillary techniques (extraductal ultrasound (EDUS), intraductal ultrasound (IDUS), cholangiopancreatoscopy with biopsies and probe-based confocal laser endomicroscopy (pCLE)). In this literary review, we retraced the recent history of EUS and ERCP, reported examples of the clinical applicability of the EURCP concept and explored the option of performing the two procedures in only one endoscopic session, with its positive implications for the patient, the endoscopist and the health care system. In the last few years, we also evaluated the possibility of combining EUS and ERCP into a single endoscopic instrument in a single step, but certain obstacles surrounding this approach remain.
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Affiliation(s)
- Claudio Giovanni De Angelis
- Gastroenterology and Digestive Endoscopy Unit, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; (M.G.)
| | - Eleonora Dall’Amico
- Gastroenterology and Digestive Endoscopy Unit, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; (M.G.)
| | - Maria Teresa Staiano
- Gastroenterology and Digestive Endoscopy Unit, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; (M.G.)
| | - Marcantonio Gesualdo
- Gastroenterology and Digestive Endoscopy Unit, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; (M.G.)
| | - Mauro Bruno
- Gastroenterology and Digestive Endoscopy Unit, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; (M.G.)
| | - Silvia Gaia
- Gastroenterology and Digestive Endoscopy Unit, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; (M.G.)
| | - Marco Sacco
- Gastroenterology and Digestive Endoscopy Unit, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; (M.G.)
| | - Federica Fimiano
- Gastroenterology and Digestive Endoscopy Unit, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; (M.G.)
| | - Anna Mauriello
- Gastroenterology and Digestive Endoscopy Unit, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; (M.G.)
| | - Simone Dibitetto
- Gastroenterology and Digestive Endoscopy Unit, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; (M.G.)
| | - Chiara Canalis
- Gastroenterology and Digestive Endoscopy Unit, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; (M.G.)
| | - Rosa Claudia Stasio
- Gastroenterology and Digestive Endoscopy Unit, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; (M.G.)
| | - Alessandro Caneglias
- Gastroenterology and Digestive Endoscopy Unit, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; (M.G.)
| | - Federica Mediati
- Gastroenterology and Digestive Endoscopy Unit, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; (M.G.)
| | - Rodolfo Rocca
- Gastroenterology Department, Mauriziano Hospital, 10128 Turin, Italy
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Khan RSA, Alam L, Khan ZA, Khan UA. Comparing the efficacy of EUS versus MRCP with ERCP as gold standard in patients presenting with partial biliary obstruction - finding a better diagnostic tool. Pak J Med Sci 2023; 39:1275-1279. [PMID: 37680787 PMCID: PMC10480756 DOI: 10.12669/pjms.39.5.7280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/06/2022] [Indexed: 09/09/2023] Open
Abstract
Objective To evaluate the diagnostic accuracy of different imaging modalities in patients with partial biliary obstruction with no obvious aetiology on initial imaging. Methods This is a prospective single-centre cohort study carried out at Pak Emirates Military Hospital, Rawalpindi from June 2019 to June 2021 with non-probability consecutive sampling. Patients with ages 16 to 75 years, presenting with partial biliary obstruction and undetermined aetiology on initial imaging (TUS and MRCP) were enrolled. EUS was performed for each of these patients and the case was regarded as "true positive" or "true negative" if the findings of imaging modality correlated to those of ERCP. ROC curve, sensitivity, specificity, PPV, NPV and AUC (with 95% confidence interval) were drawn for all the diagnostic tools using SPSS V. 21. Results A total of 65 patients were enrolled over a period of two years with male to female ratio of 1.4:1. Forty-four patients had an intermediate risk of choledocholithiasis upon preliminary evaluation whereas, 48(74%) of the participants had CBD calculi or sludge confirmed upon subsequent ERCP. Trans-abdominal ultrasound showed the lowest sensitivity (29.2%), specificity (85%), NPV 12% and PPV 93% for diagnosing CBD calculi. This was followed by MRCP with a sensitivity of 37.5%, specificity of 100%, NPV of 36.2% and PPV of 100%. EUS showed the maximum diagnostic accuracy with AUC of 1.0 and a 100% sensitivity and specificity when compared with ERCP as gold standard. Conclusion EUS is superior to MRCP in terms of diagnostic accuracy as minimally invasive diagnostic tool and EUS superiority is particularly relevant in patients with intermediate risk of choledocholithiasis.
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Affiliation(s)
- Rao Saad Ali Khan
- Rao Saad Ali Khan, FCPS Med, FCPS Gastroenterology, FRCP Consultant Gastroenterology and Transplant Hepatologist, Pak Emirates Military Hospital, Rawalpindi Pakistan
| | - Laima Alam
- Laima Alam, FCPS Gastroenterology, MRCP (UK), CHPE Consultant Gastroenterology, Bahria International Hospital, Rawalpindi Pakistan
| | - Zoya Ali Khan
- Zoya Ali Khan, Research Assistant, Pak Emirates Military Hospital, Rawalpindi Pakistan
| | - Uzair Ali Khan
- Uzair Ali Khan, Research Assistant, Pak Emirates Military Hospital, Rawalpindi Pakistan
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Role of endoscopic ultrasound in the evaluation of unexplained extrahepatic bile duct dilatation. Eur J Gastroenterol Hepatol 2023; 35:73-79. [PMID: 36468572 DOI: 10.1097/meg.0000000000002485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE This study was performed to assess the diagnostic performance of endoscopic ultrasonography (EUS) in patients with extrahepatic bile duct (EBD) dilatation and develop a novel model incorporating EUS-based signature with clinical parameters for distinguishing the malignant dilation of EBD. METHODS The EUS data and clinical parameters of the patients were collected and analyzed retrospectively. First, we evaluated the diagnostic performance of EUS in detecting the cause of EBD dilatation. Then, we performed univariate and multivariate binary logistic regression analyses based on clinical and EUS features. Finally, a nomogram was established to aid in distinguishing between malignant dilation and noncalculous benign dilatation of EBD in patients. RESULTS A total of 184 patients were enrolled. For the diagnosis of malignant dilation, EUS achieved an accuracy of 90.76%, sensitivity of 85.96%, and specificity of 92.91%. For the diagnosis of calculous dilation, EUS achieved an accuracy of 100%, sensitivity of 100%, and specificity of 100%. For the diagnosis of noncalculous benign dilatation, EUS achieved an accuracy of 90.76%, sensitivity of 90.90%, and specificity of 90.58%. Multivariable logistic regression analyses indicated that abnormal liver function test, elevated tumor markers, and EUS findings were the well-diagnostic factors of malignant EBD dilation. The nomogram established by these factors showed good calibration and discrimination. CONCLUSION EUS is a useful examinational modality in the work-up of EBD dilatation. In combination with abnormal liver function test and elevated tumor markers, EUS may provide additional information for the detection of malignant dilation of EBD and should be further investigated.
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Hakim S, Sethi A. Value of Endoscopic Ultrasonography in Evaluating Unexplained Isolated Common Bile Duct Dilation on Imaging. Clin Endosc 2022; 55:47-48. [PMID: 35135180 PMCID: PMC8831401 DOI: 10.5946/ce.2022.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/08/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Seifeldin Hakim
- Division of Digestive and Liver Disease Columbia University Medical Center, NY, USA
| | - Amrita Sethi
- Division of Digestive and Liver Disease Columbia University Medical Center, NY, USA
- Correspondence: Amrita Sethi Columbia University Medical Center, 630 W 168th St , P&S, 3-401, New York, NY 10032, USA Tel: +1-212-305-1909, Fax: +1-212-305-1081, E-mail:
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