The role of endoscopic ultrasonography in biliary tract disease: obstructive jaundice

Forty-one patients (22 females, 19 males, mean age 74 years, range 41-93) with extrahepatic obstructive jaundice were evaluated by transcutaneous sonography (US), endoscopic ultrasonography (EUS), and endoscopic retrograde cholangiopancreatography (ERCP) within 24 hours of hospital admission. EUS was always performed after US and immediately prior to ERCP, the latter being considered the "gold standard" for this study. EUS findings were documented according to a pre-set data protocol in a blind fashion with respect to ERCP results. Common bile duct (CBD) dilatation was demonstrated by all three methods. Stones in the distal CBD causing obstruction were demonstrated by EUS in 15 out of 16 patients, but in only seven cases by US. In 25 patients, the underlying malignant disease was identified by EUS as well as ERCP, and the level of biliary obstruction was correctly determined by both methods, while with US this was possible only in 17 (89%) and 20 (80%) cases, respectively. In comparison with ERCP, EUS provided a direct image of the tumor and allowed for regional staging in all patients. EUS was superior to US in elucidating the cause of biliary obstruction. EUS provides an additional means to decide quickly on appropriate therapy. At present, a shortcoming of the method is that no therapeutic interventions can be performed during EUS examination.