Endoscopic Ultrasonography Can Prevent Unnecessary Diagnostic Endoscopic Retrograde Cholangiopancreatography Even in Patients with High Likelihood of Choledocholithiasis and Inconclusive Ultrasonography: Results of a Prospective Study

Background/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is the initial therapy recommended for patients with high likelihood of choledocholithiasis. To determine whether endoscopic ultrasonography (EUS) can prevent diagnostic ERCPs in patients with high probability of choledocholithia...

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Veröffentlicht in:Clinical endoscopy 2017-11, Vol.50 (6), p.592
Hauptverfasser: Ruchir Patel, Meghraj Ingle, Dhaval Choksi, Prateik Poddar, Vikas Pandey, Prabha Sawant
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container_end_page
container_issue 6
container_start_page 592
container_title Clinical endoscopy
container_volume 50
creator Ruchir Patel
Meghraj Ingle
Dhaval Choksi
Prateik Poddar
Vikas Pandey
Prabha Sawant
description Background/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is the initial therapy recommended for patients with high likelihood of choledocholithiasis. To determine whether endoscopic ultrasonography (EUS) can prevent diagnostic ERCPs in patients with high probability of choledocholithiasis and inconclusive ultrasonography (US). Methods: All patients with high likelihood of choledocholithiasis and negative US underwent EUS. ERCP was performed for the patients who showed a definite stone/sludge on EUS. Patients without choledocholithiasis were followed up for 3 months. The primary outcome was avoidance of diagnostic ERCP. Results: We included 78 patients (51 women; 27 men). Of these, 25 and 7 (total 41%) were diagnosed with choledocholithiasis and sludge, respectively; stone/sludge was removed in 96.9% of the patients. EUS ruled out choledocholithiasis in 38 patients (48.7%). Two of them were found to have choledocholithiasis on follow-up. The sensitivity, specificity, positive and negative predictive value of EUS for detecting choledocholithiasis were 93.9%, 97.3%, 96.9%, and 94.7%, respectively. Unnecessary ERCP was avoided in 57.7% of the patients by using the EUS-first approach. Conclusions: EUS is a highly accurate and safe procedure. EUS can replace ERCP as the initial investigation in patients with a high probability of choledocholithiasis. It avoids unnecessary ERCP; hence, decreasing related costs and complications. Clin Endosc 2017;50:592-597
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To determine whether endoscopic ultrasonography (EUS) can prevent diagnostic ERCPs in patients with high probability of choledocholithiasis and inconclusive ultrasonography (US). Methods: All patients with high likelihood of choledocholithiasis and negative US underwent EUS. ERCP was performed for the patients who showed a definite stone/sludge on EUS. Patients without choledocholithiasis were followed up for 3 months. The primary outcome was avoidance of diagnostic ERCP. Results: We included 78 patients (51 women; 27 men). Of these, 25 and 7 (total 41%) were diagnosed with choledocholithiasis and sludge, respectively; stone/sludge was removed in 96.9% of the patients. EUS ruled out choledocholithiasis in 38 patients (48.7%). Two of them were found to have choledocholithiasis on follow-up. The sensitivity, specificity, positive and negative predictive value of EUS for detecting choledocholithiasis were 93.9%, 97.3%, 96.9%, and 94.7%, respectively. Unnecessary ERCP was avoided in 57.7% of the patients by using the EUS-first approach. Conclusions: EUS is a highly accurate and safe procedure. EUS can replace ERCP as the initial investigation in patients with a high probability of choledocholithiasis. It avoids unnecessary ERCP; hence, decreasing related costs and complications. Clin Endosc 2017;50:592-597</description><identifier>ISSN: 2234-2400</identifier><language>kor</language><publisher>대한소화기내시경학회</publisher><subject>Choledocholithiasis ; Endosonography ; High likelihood ; Inconclusive imaging ; Unnecessary endoscopic retrograde cholangiopancreatography</subject><ispartof>Clinical endoscopy, 2017-11, Vol.50 (6), p.592</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,782,786</link.rule.ids></links><search><creatorcontrib>Ruchir Patel</creatorcontrib><creatorcontrib>Meghraj Ingle</creatorcontrib><creatorcontrib>Dhaval Choksi</creatorcontrib><creatorcontrib>Prateik Poddar</creatorcontrib><creatorcontrib>Vikas Pandey</creatorcontrib><creatorcontrib>Prabha Sawant</creatorcontrib><title>Endoscopic Ultrasonography Can Prevent Unnecessary Diagnostic Endoscopic Retrograde Cholangiopancreatography Even in Patients with High Likelihood of Choledocholithiasis and Inconclusive Ultrasonography: Results of a Prospective Study</title><title>Clinical endoscopy</title><addtitle>Clinical Endoscopy</addtitle><description>Background/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is the initial therapy recommended for patients with high likelihood of choledocholithiasis. To determine whether endoscopic ultrasonography (EUS) can prevent diagnostic ERCPs in patients with high probability of choledocholithiasis and inconclusive ultrasonography (US). Methods: All patients with high likelihood of choledocholithiasis and negative US underwent EUS. ERCP was performed for the patients who showed a definite stone/sludge on EUS. Patients without choledocholithiasis were followed up for 3 months. The primary outcome was avoidance of diagnostic ERCP. Results: We included 78 patients (51 women; 27 men). Of these, 25 and 7 (total 41%) were diagnosed with choledocholithiasis and sludge, respectively; stone/sludge was removed in 96.9% of the patients. EUS ruled out choledocholithiasis in 38 patients (48.7%). Two of them were found to have choledocholithiasis on follow-up. The sensitivity, specificity, positive and negative predictive value of EUS for detecting choledocholithiasis were 93.9%, 97.3%, 96.9%, and 94.7%, respectively. Unnecessary ERCP was avoided in 57.7% of the patients by using the EUS-first approach. Conclusions: EUS is a highly accurate and safe procedure. EUS can replace ERCP as the initial investigation in patients with a high probability of choledocholithiasis. It avoids unnecessary ERCP; hence, decreasing related costs and complications. Clin Endosc 2017;50:592-597</description><subject>Choledocholithiasis</subject><subject>Endosonography</subject><subject>High likelihood</subject><subject>Inconclusive imaging</subject><subject>Unnecessary endoscopic retrograde cholangiopancreatography</subject><issn>2234-2400</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><recordid>eNp9j8FKw1AQRbNQsGi_wM38QCEmMYLbWKngQtSuy_jeNBkaZ8Kbl0p-2a_wVRSkC1d3Mfcc7pxks6Ioq0VR5flZNjfjt7yqbsryqs5n2edSvJrTgR2s-xjQVLQNOHQTNCjwFGhPEmEtQo7MMExwx9iKWkzIH_qZYjiQnqDptEdpWQcUFwjjr3GZXMDJipGT1eCDYwcrbjt45B313Kl60O23gby6FKnBaGyA4uFBnIrrR-M9He-9TRNs7JM1CTAtVxvIxUPzJY5-ushOt9gbzX_yPLu8X742q8WOzTZD4Pf03Ka8rqsir8v_r19yB3UW</recordid><startdate>20171130</startdate><enddate>20171130</enddate><creator>Ruchir Patel</creator><creator>Meghraj Ingle</creator><creator>Dhaval Choksi</creator><creator>Prateik Poddar</creator><creator>Vikas Pandey</creator><creator>Prabha Sawant</creator><general>대한소화기내시경학회</general><scope>HZB</scope><scope>Q5X</scope></search><sort><creationdate>20171130</creationdate><title>Endoscopic Ultrasonography Can Prevent Unnecessary Diagnostic Endoscopic Retrograde Cholangiopancreatography Even in Patients with High Likelihood of Choledocholithiasis and Inconclusive Ultrasonography: Results of a Prospective Study</title><author>Ruchir Patel ; Meghraj Ingle ; Dhaval Choksi ; Prateik Poddar ; Vikas Pandey ; Prabha Sawant</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-kiss_primary_35642063</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>kor</language><creationdate>2017</creationdate><topic>Choledocholithiasis</topic><topic>Endosonography</topic><topic>High likelihood</topic><topic>Inconclusive imaging</topic><topic>Unnecessary endoscopic retrograde cholangiopancreatography</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ruchir Patel</creatorcontrib><creatorcontrib>Meghraj Ingle</creatorcontrib><creatorcontrib>Dhaval Choksi</creatorcontrib><creatorcontrib>Prateik Poddar</creatorcontrib><creatorcontrib>Vikas Pandey</creatorcontrib><creatorcontrib>Prabha Sawant</creatorcontrib><collection>Korean Studies Information Service System (KISS)</collection><collection>Korean Studies Information Service System (KISS) B-Type</collection><jtitle>Clinical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ruchir Patel</au><au>Meghraj Ingle</au><au>Dhaval Choksi</au><au>Prateik Poddar</au><au>Vikas Pandey</au><au>Prabha Sawant</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Endoscopic Ultrasonography Can Prevent Unnecessary Diagnostic Endoscopic Retrograde Cholangiopancreatography Even in Patients with High Likelihood of Choledocholithiasis and Inconclusive Ultrasonography: Results of a Prospective Study</atitle><jtitle>Clinical endoscopy</jtitle><addtitle>Clinical Endoscopy</addtitle><date>2017-11-30</date><risdate>2017</risdate><volume>50</volume><issue>6</issue><spage>592</spage><pages>592-</pages><issn>2234-2400</issn><abstract>Background/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is the initial therapy recommended for patients with high likelihood of choledocholithiasis. To determine whether endoscopic ultrasonography (EUS) can prevent diagnostic ERCPs in patients with high probability of choledocholithiasis and inconclusive ultrasonography (US). Methods: All patients with high likelihood of choledocholithiasis and negative US underwent EUS. ERCP was performed for the patients who showed a definite stone/sludge on EUS. Patients without choledocholithiasis were followed up for 3 months. The primary outcome was avoidance of diagnostic ERCP. Results: We included 78 patients (51 women; 27 men). Of these, 25 and 7 (total 41%) were diagnosed with choledocholithiasis and sludge, respectively; stone/sludge was removed in 96.9% of the patients. EUS ruled out choledocholithiasis in 38 patients (48.7%). Two of them were found to have choledocholithiasis on follow-up. The sensitivity, specificity, positive and negative predictive value of EUS for detecting choledocholithiasis were 93.9%, 97.3%, 96.9%, and 94.7%, respectively. Unnecessary ERCP was avoided in 57.7% of the patients by using the EUS-first approach. Conclusions: EUS is a highly accurate and safe procedure. EUS can replace ERCP as the initial investigation in patients with a high probability of choledocholithiasis. It avoids unnecessary ERCP; hence, decreasing related costs and complications. Clin Endosc 2017;50:592-597</abstract><pub>대한소화기내시경학회</pub><tpages>6</tpages></addata></record>
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subjects Choledocholithiasis
Endosonography
High likelihood
Inconclusive imaging
Unnecessary endoscopic retrograde cholangiopancreatography
title Endoscopic Ultrasonography Can Prevent Unnecessary Diagnostic Endoscopic Retrograde Cholangiopancreatography Even in Patients with High Likelihood of Choledocholithiasis and Inconclusive Ultrasonography: Results of a Prospective Study
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