The role of endoscopic ultrasound (EUS) in detecting common bile duct (CBD) stones missed post-endoscopic retrograde cholangiopancreatography (ERCP) in patients with calculous obstructive jaundice
Abstract Background Choledocholithiasis occurs in up to 20% of patients with gallstones. Diagnosing choledocholithiasis can be challenging. Previously, the gold standard for diagnosis was endoscopic retrograde cholangiopancreatography (ERCP). However, small stones often evade detection through ERCP...
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SpringerOpen
2024-11-01
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| Series: | The Egyptian Journal of Internal Medicine |
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| Online Access: | https://doi.org/10.1186/s43162-024-00374-w |
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| author | Mohamed Badr Hassan Ahmed Morad Hashim Mahmoud Abd Elnabi Mohamed Darwish Abeer Abdellatef |
| author_facet | Mohamed Badr Hassan Ahmed Morad Hashim Mahmoud Abd Elnabi Mohamed Darwish Abeer Abdellatef |
| author_sort | Mohamed Badr Hassan |
| collection | DOAJ |
| description | Abstract Background Choledocholithiasis occurs in up to 20% of patients with gallstones. Diagnosing choledocholithiasis can be challenging. Previously, the gold standard for diagnosis was endoscopic retrograde cholangiopancreatography (ERCP). However, small stones often evade detection through ERCP and magnetic resonance cholangiopancreatography (MRCP). Endoscopic ultrasound (EUS) has proven effective in identifying common bile duct (CBD) stones that MRCP and ERCP might miss, particularly small stones or those lodged in the distal CBD or papillary region. The study aimed to evaluate the accuracy of EUS in detecting CBD stones missed by MRCP and ERCP. Methods A case–control study was conducted; we enrolled 30 patients who were presented with calculous obstructive jaundice and had undergone both ERCP and MRCP. A stent was inserted in these patients. Prior to stent removal, these patients underwent EUS to evaluate its effectiveness in detecting any remaining CBD stones post-ERCP. The sensitivity and specificity of EUS, ERCP, and MRCP were compared based on the presence, size, and number of detected stones. Results The mean age of involved patients was 50.3 ± 10.2 years. ERCP demonstrated a sensitivity of 44.4%, specificity of 100%, positive predictive value (PPV) of 100%, negative predictive value (NPV) of 16.6%, and an accuracy of 50%. MRCP showed a sensitivity of 81.5%, specificity of 100%, PPV of 100%, NPV of 37.5%, and an accuracy of 83.3% when compared with EUS results. The complication rate for EUS was significantly lower than that for diagnostic ERCP. Additionally, an EUS-based strategy was more cost-effective than diagnostic ERCP for patients with low, moderate, or high risk. Conclusion Endoscopic ultrasound (EUS) is a promising, non-invasive, non-contrast technique that may serve as a superior diagnostic tool compared with MRCP and ERCP, particularly for detecting small stones or those impacted in the distal CBD or papillary region. |
| format | Article |
| id | doaj-art-389fee807ddd4a1db19aca6cc0849dff |
| institution | OA Journals |
| issn | 2090-9098 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | The Egyptian Journal of Internal Medicine |
| spelling | doaj-art-389fee807ddd4a1db19aca6cc0849dff2025-08-20T02:38:39ZengSpringerOpenThe Egyptian Journal of Internal Medicine2090-90982024-11-013611810.1186/s43162-024-00374-wThe role of endoscopic ultrasound (EUS) in detecting common bile duct (CBD) stones missed post-endoscopic retrograde cholangiopancreatography (ERCP) in patients with calculous obstructive jaundiceMohamed Badr Hassan0Ahmed Morad Hashim1Mahmoud Abd Elnabi Mohamed Darwish2Abeer Abdellatef3Cairo UniversityCairo UniversityCairo UniversityCairo UniversityAbstract Background Choledocholithiasis occurs in up to 20% of patients with gallstones. Diagnosing choledocholithiasis can be challenging. Previously, the gold standard for diagnosis was endoscopic retrograde cholangiopancreatography (ERCP). However, small stones often evade detection through ERCP and magnetic resonance cholangiopancreatography (MRCP). Endoscopic ultrasound (EUS) has proven effective in identifying common bile duct (CBD) stones that MRCP and ERCP might miss, particularly small stones or those lodged in the distal CBD or papillary region. The study aimed to evaluate the accuracy of EUS in detecting CBD stones missed by MRCP and ERCP. Methods A case–control study was conducted; we enrolled 30 patients who were presented with calculous obstructive jaundice and had undergone both ERCP and MRCP. A stent was inserted in these patients. Prior to stent removal, these patients underwent EUS to evaluate its effectiveness in detecting any remaining CBD stones post-ERCP. The sensitivity and specificity of EUS, ERCP, and MRCP were compared based on the presence, size, and number of detected stones. Results The mean age of involved patients was 50.3 ± 10.2 years. ERCP demonstrated a sensitivity of 44.4%, specificity of 100%, positive predictive value (PPV) of 100%, negative predictive value (NPV) of 16.6%, and an accuracy of 50%. MRCP showed a sensitivity of 81.5%, specificity of 100%, PPV of 100%, NPV of 37.5%, and an accuracy of 83.3% when compared with EUS results. The complication rate for EUS was significantly lower than that for diagnostic ERCP. Additionally, an EUS-based strategy was more cost-effective than diagnostic ERCP for patients with low, moderate, or high risk. Conclusion Endoscopic ultrasound (EUS) is a promising, non-invasive, non-contrast technique that may serve as a superior diagnostic tool compared with MRCP and ERCP, particularly for detecting small stones or those impacted in the distal CBD or papillary region.https://doi.org/10.1186/s43162-024-00374-wCholedocholithiasisEndoscopic retrograde cholangiopancreatography (ERCP)Magnetic resonance cholangiopancreatography (MRCP)Endoscopic ultrasound (EUS)Missed CBD stones |
| spellingShingle | Mohamed Badr Hassan Ahmed Morad Hashim Mahmoud Abd Elnabi Mohamed Darwish Abeer Abdellatef The role of endoscopic ultrasound (EUS) in detecting common bile duct (CBD) stones missed post-endoscopic retrograde cholangiopancreatography (ERCP) in patients with calculous obstructive jaundice The Egyptian Journal of Internal Medicine Choledocholithiasis Endoscopic retrograde cholangiopancreatography (ERCP) Magnetic resonance cholangiopancreatography (MRCP) Endoscopic ultrasound (EUS) Missed CBD stones |
| title | The role of endoscopic ultrasound (EUS) in detecting common bile duct (CBD) stones missed post-endoscopic retrograde cholangiopancreatography (ERCP) in patients with calculous obstructive jaundice |
| title_full | The role of endoscopic ultrasound (EUS) in detecting common bile duct (CBD) stones missed post-endoscopic retrograde cholangiopancreatography (ERCP) in patients with calculous obstructive jaundice |
| title_fullStr | The role of endoscopic ultrasound (EUS) in detecting common bile duct (CBD) stones missed post-endoscopic retrograde cholangiopancreatography (ERCP) in patients with calculous obstructive jaundice |
| title_full_unstemmed | The role of endoscopic ultrasound (EUS) in detecting common bile duct (CBD) stones missed post-endoscopic retrograde cholangiopancreatography (ERCP) in patients with calculous obstructive jaundice |
| title_short | The role of endoscopic ultrasound (EUS) in detecting common bile duct (CBD) stones missed post-endoscopic retrograde cholangiopancreatography (ERCP) in patients with calculous obstructive jaundice |
| title_sort | role of endoscopic ultrasound eus in detecting common bile duct cbd stones missed post endoscopic retrograde cholangiopancreatography ercp in patients with calculous obstructive jaundice |
| topic | Choledocholithiasis Endoscopic retrograde cholangiopancreatography (ERCP) Magnetic resonance cholangiopancreatography (MRCP) Endoscopic ultrasound (EUS) Missed CBD stones |
| url | https://doi.org/10.1186/s43162-024-00374-w |
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