Diagnostic significance of endoscopic ultrasonography in common bile duct stones / 中华消化内镜杂志

ABSTRACT

Objective To study on the effectiveness of endoscopic ultrasonography (EUS) in diagnosing common bile duct (CBD) stones. Methods Accuracies for the diagnosis of choledocholithiasis by abdominal ultrasonography ( B-US) and computed tomography (CT) are compared with those by EUS in 45 patients. Final diagnosis is determined by endoscopic retrograde cholangiography ( ERC) with or without sphincterotomy ( EST) or operative exploration. Results Forty-three out of 45 patients with choledtx-holithia sis were diagnosed by EUS, of them 2 patients with slight dilation of common bile duct in which stones were confirmed in the proximal part of common bile duct by EST. In 2 out of 43 patients EST and operation diagnosed cholecystolithiasis instead of choledocholilhiasis. The sensitivity and the positive predictive value are both 95%. With 41 patients choledocholithiasis were confirmed by EUS, the sizes of stone were diameter ≥ 10mm in 5 patients, 6-9 mm in 10 patients and ≤5mm in 26 patients. Four out of 45 patients were suspected to have CBD stones and 2 patients had tumor in periampullar area by B-US. Three patients were diagnosed to have CBD stone and 1 patient was suspected to have tumor in peri-ampullar area by CT. Conclusions EUS appears to be the best diagnostic tool for the diagnosis of choledocholithiasis compared with other noninvasive procedures such as B-US and CT. EUS is at least as sensitive as ERC especially in diagnosis of small CBD stones.