Role of endoscopic ultrasound in evaluation of patients with missed common bile duct stones

Table 1 Biochemical data of the included patients

	n	%
Alanine transaminase, aspartate aminotransferase	Up to 33 U/L
Normal	36	40.0
< 3 fold	44	48.9
≥ 3 fold	10	11.1
Bilirubin	Up to 1.1 mg/dL
Normal	17	18.9
Yes	73	81.1
< 5 mg/100 mL	54	74.0
≥ 5 mg/100 mL	19	26.0
Min-Max	1.40-20.0
mean ± SD	3.99 ± 3.30
Median (IQR)	3.0 (2.0-5.0)
Alkaline phosphatase	35-104 U/L
GGT	Up to 40 U/L
Normal	7	7.8
< 3 fold	24	26.7
≥ 3 fold	59	65.6

IQR: Interquartile range; GGT: Gamma glutamyl transpeptidase.

Table 2 Cases of choledocholithiasis detected by endoscopic ultrasound

Common bile duct stones detected by endoscopic ultrasound	Patients (n)	%
Common bile duct stones detected by endoscopic ultrasound
No	15	16.7
Yes	75	83.3
Stones (n)
No stones	20	22.2
1	42	46.7
2	12	13.3
3	5	5.6
4	1	1.1
5	1	1.1
6	1	1.1
Multiple	8	8.9
Size of stones (mm)
No stones	20	22.2
Gravels (1-2 mm)	2	2.2
3-5	25	27.8
> 5	43	47.8

Table 3 Accuracy, sensitivity, and specificity of endoscopic ultrasound and magnetic resonance cholangiopancreatography in detecting choledocholithiasis

	Endoscopic retrograde cholangiopancreatography findings				Sensitivity	Specificity	PPV	NPV	Accuracy
	No (n = 23)		Yes (n = 67)
CBD stones detected by EUS	n	%	n	%
No	14	60.9	1	1.5	98.51	60.87	88.0	93.33	88.89
Yes	9	39.1	66	98.5
FEP value	43.464 (< 0.001)
MRCP stones	n	%	n	%
No	23	100.0	30	44.8
Yes	0	0.0	37	55.2	55.22	100.0	100.0	43.40	66.67
P value	21.569 (< 0.001)

PPV: Positive predictive value; NPV: Negative predictive value; CBD: Common bile duct; EUS: Endoscopic ultrasound; MRCP: Magnetic resonance cholangiopancreatography; ERCP: Endoscopic retrograde cholangiopancreatography.

Table 4 Agreement (sensitivity, specificity, and accuracy) for combined endoscopic ultrasound and magnetic resonance cholangiopancreatography

Combined EUSMRCP	ERCP findings				Sensitivity	Specificity	PPV	NPV	Accuracy
	No (n = 11)		Yes (n = 36)
	n	%	n	%
No	11	100.0	1	2.8	97.22	100.0	100.0	91.67	97.87
Yes	0	0.0	35	97.2
FEP value	41.887 (< 0.001)

PPV: Positive predictive value; NPV: Negative predictive value; EUS: Endoscopic ultrasound; MRCP: Magnetic resonance cholangiopancreatography; ERCP: Endoscopic retrograde cholangiopancreatography.

Table 5 Differences in endoscopic skill between expert and non-expert endoscopists

CBD stones detected by EUS	Total (n = 90)					Non-expert (n = 27)		Expert (n = 63)
	n				%	n	%	n	%
No	15				16.7	11	40.7	4	6.3
Yes	75				83.3	16	59.3	59	93.7
Number
No.	20				22.2	14	51.9	6	9.5
1	42				46.7	8	29.6	34	54.0
2	12				13.3	2	7.4	10	15.9
3	5				5.6	0	0.0	5	7.9
4	1				1.1	0	0.0	1	1.6
5	1				1.1	0	0.0	1	1.6
6	1				1.1	0	0.0	1	1.6
Multiple	8				8.9	3	11.1	5	7.9
Size (mm)
No.	22				24.4	14	51.9	8	12.7
≤ 5	25				27.8	4	14.8	21	33.3
> 5	43				47.8	9	33.3	34	54.0
Other findings of EUS
No	65				72.2	14	51.9	51	81.0
Yes	25				27.8	13	48.1	12	19.0
	ERCP findings				Sensitivity	Specificity	PPV	NPV	Accuracy
	No		Yes
	n	%	n	%
Total sample (n = 90)	n = 23		n = 67
No	14	60.9	1	1.5
Yes	9	39.1	66	98.5	98.51	60.87	88.0	93.33	88.89
FEP value	43.464 (< 0.001)
Non-expert (n = 27)	n = 13		n = 14
No	10	76.9	1	7.1
Yes	3	23.1	13	92.9	92.86	76.92	81.25	90.91	85.19
FEP value	13.595 (< 0.001)
Expert (n = 63)	n = 10		n = 53
No	4	40.0	0	0.0
Yes	6	60.0	53	100.0	100.0	40.0	89.83	100.0	90.48
FEP value	22.637 (< 0.001)

PPV: Positive predictive value; NPV: Negative predictive value; EUS: Endoscopic ultrasound; MRCP: Magnetic resonance cholangiopancreatography; ERCP: Endoscopic retrograde cholangiopancreatography.