Eissa M, Okasha HH, Abbasy M, Khamis AK, Abdellatef A, Rady MA. Role of endoscopic ultrasound in evaluation of patients with missed common bile duct stones. World J Gastrointest Endosc 2022; 14(9): 564-574 [PMID: 36186945 DOI: 10.4253/wjge.v14.i9.564]
Corresponding Author of This Article
Abeer Abdellatef, MD, Lecturer, Department of Internal Medicine, Hepatogastroenterology Division, Kasr AL-Ainy School of Medicine, Cairo University, Kasr Al-Aini Street, Cairo 11451, Egypt. beero4a@yahoo.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Prospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Sep 16, 2022; 14(9): 564-574 Published online Sep 16, 2022. doi: 10.4253/wjge.v14.i9.564
Role of endoscopic ultrasound in evaluation of patients with missed common bile duct stones
Mohamed Eissa, Hussein Hassan Okasha, Mohamed Abbasy, Ahmed Kamal Khamis, Abeer Abdellatef, Mohamed Akl Rady
Mohamed Eissa, Mohamed Abbasy, Ahmed Kamal Khamis, Mohamed Akl Rady, Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Menoufia 32951, Egypt
Hussein Hassan Okasha, Abeer Abdellatef, Department of Internal Medicine, Hepatogastroenterology Division, Kasr AL-Ainy School of Medicine, Cairo University, Cairo 11451, Egypt
Author contributions: Eissa M and Rady MA contributed equally in collecting the data and writing the manuscript; Abdellatef A read and revised the manuscript; Abbasy M and Kamal A read and approved the manuscript; Okasha HH revised and approved the final manuscript; all authors have read and approved the final manuscript.
Institutional review board statement: Our institution’s Research Ethical Committee approved the study, and all patients gave their informed written consent before inclusion in the study, according to the ethical guidelines of the 1975 Declaration of Helsinki. The National Liver Institute IRB protocol number is 00305/2022.
Clinical trial registration statement: The clinical trial is registered with Brazilian Clinical Trials Registry (ReBec).
Informed consent statement: All study participants, or their legal guardian, provided written consent prior to study enrollment.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Abeer Abdellatef, MD, Lecturer, Department of Internal Medicine, Hepatogastroenterology Division, Kasr AL-Ainy School of Medicine, Cairo University, Kasr Al-Aini Street, Cairo 11451, Egypt. beero4a@yahoo.com
Received: June 2, 2022 Peer-review started: June 2, 2022 First decision: July 12, 2022 Revised: July 26, 2022 Accepted: September 6, 2022 Article in press: September 6, 2022 Published online: September 16, 2022 Processing time: 104 Days and 3.4 Hours
Abstract
BACKGROUND
Choledocholithiasis develops in up to 20% of patients with gall bladder stones. The challenge in diagnosis usually occurs with small stones that may be missed by magnetic resonance cholangiopancreatography (MRCP). Endoscopic ultrasound (EUS) is accurate in detecting common bile duct (CBD) stones missed by MRCP, especially the small ones or those impacted at the distal CBD or the papillary region.
AIM
To evaluate the accuracy of EUS in detecting CBD stones missed by MRCP.
METHODS
Patients with an intermediate likelihood of choledocholithiasis according to ESGE guidelines and those with acute pancreatitis of undetermined cause were included. The presence of choledocholithiasis was evaluated by MRCP and EUS, and then results were confirmed by endoscopic retrograde cholangiopancreatography (ERCP). The sensitivity and specificity of EUS and MRCP were compared regarding the presence of stones, the size, and the number of detected stones.
RESULTS
Ninety out of 100 involved patients had choledocholithiasis, while ten patients were excluded as they had pancreatic or gall bladder masses during EUS examination. In choledocholithiasis patients, the mean age was 52.37 ± 14.64 years, and 52.2% were males. Most patients had biliary obstruction (74.4%), while only 23 (25.6%) patients had unexplained pancreatitis. The overall prevalence of choledocholithiasis was 83.3% by EUS, 41.1% by MRCP, and 74.4% by ERCP. Also, the number and size of CBD stones could be detected accurately in 78.2% and 75.6% by EUS and 41.1% and 70.3% by MRCP, respectively. The sensitivity of EUS was higher than that of MRCP (98.51% vs 55.22%), and their predictive value was statistically different (P < 0.001). Combination of both tools raised the sensitivity to 97.22% and specificity to 100%.
CONCLUSION
EUS could be a useful tool in assessing patients with suspected choledocholithiasis especially if combined with MRCP. However, its usefulness depends on its availability and the experience of the local centers.
Core Tip: Still, there is a great challenge in diagnosing suspected cases of choledocholithiasis that could develop in up to 20% of patients with gall bladder stones. Endoscopic ultrasound (EUS) can easily detect small stones that magnetic resonance cholangiopancreatography (MRCP) could miss. EUS still has many diagnostic purposes with high accuracy in detecting common bile duct (CBD) stones missed by MRCP, especially the small ones or those impacted at the distal CBD or the papillary region.
