[Endoscopic ultrasonography in the diagnosis of choledocholithiasis]

Endoscopic retrograde cholangiopancreatography (ERCP) has been considered a gold standard in the diagnosis of choledocholithiasis; however, the incidence of complications is high. In literature reports, the morbidity rate ranges from 5% to 19% and mortality rate from 0.1% to 1.3%, therefore an effective but less invasive new method of diagnosing choledocholithiasis is required. In a number of trials, endoscopic ultrasonography (EUS) has been shown to be a less invasive method with excellent sensitivity of 94% and specificity of 95%. The aim of this study was to estimate the sensitivity and specificity of EUS in patients with suspected choledocholithiasis and to establish its role in the algorithm for diagnosing choledocholithiasis.

Patient files were retrospectively reviewed in 209 patients with a clinical picture and ultrasonography findings suggestive of choledocholithiasis, admitted to Sestre milosrdnice University Hospital during a six-month period (Sep 1, 2007 - Feb 29, 2008) and submitted to ERCP within 72 hours of admission.

In 125 patients with abdominal ultrasonography findings suggestive of choledocholithiasis (biliary obstruction without clear evidence of calculi), EUS was performed before ERCR. Choledocholithiasis or biliary sludge was identified in 66 (62.3%) patients, 29 (27.3%) patients were free from biliary abnormalities, and 11 (10.4%) patients had stenosis of different etiology. In 64 of 66 (96.9%) patients, the diagnosis was confirmed by ERCP. Another two (3.1%) patients had no evidence of choledocholithiasis on ERCP. There were no complications related to EUS.

EUS is an effective method for diagnosing choledocholithiasis with a sensitivity and specificity comparable to ERCP. Therefore, it is reasonable to use EUS as the first method of choice in patients with suspected choledocholithiasis.