Premium
Endosonography‐ vs. endoscopic retrograde cholangiopancreatography‐based strategies in the evaluation of suspected common bile duct stones in patients with normal transabdominal imaging
Author(s) -
ANG T. L.,
TEO E. K.,
FOCK K. M.
Publication year - 2007
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2007.03463.x
Subject(s) - medicine , endoscopic retrograde cholangiopancreatography , common bile duct , radiology , cholestasis , bile duct , ampulla of vater , ampulla , periampullary cancer , pancreatitis , acute pancreatitis , bile duct diseases , gastroenterology , pancreatic cancer , cancer , carcinoma
Summary Background Endosonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) are highly accurate techniques for evaluating common bile duct stones. Aim To compare the clinical impact and costs of EUS‐ and ERCP‐based strategies for evaluating patients with suspected common bile duct stones but normal transabdominal imaging. Methods The costs of EUS‐ vs. ERCP‐based strategies were compared in patients with suspected acute biliary obstruction from common bile duct stones but normal transabdominal imaging. Results Over a 15‐month period, 110 patients were recruited. EUS detected a common bile duct lesion in 73% (common bile duct stones: 68%; pancreatic cancer: 2%; ampulla tumour: 2%; cholangiocarcinoma: 1%). The sensitivity, specificity, positive predictive value and negative predictive value of EUS were 98%, 100%, 100% and 93%, respectively. EUS prevented 30% unnecessary ERCP. The mean difference in cost per patient between EUS‐ and ERCP‐based strategies was US$166. When stratified according to clinical indications, an EUS‐based strategy was costlier only in suspected biliary sepsis. Costs were similar when the indications were cholestatic jaundice, acute pancreatitis and cholestasis. Conclusion EUS prior to biliary interventions in patients with suspected common bile duct stones prevented unnecessary ERCP. It allowed a definitive diagnosis to be made prior to more invasive procedures.