Diagnostic Accuracy of Endoscopic Ultrasound in Evaluation of Patients With Obstructive Jaundice: Single Center Experience

Aims We prospectively evaluated the role of EUS in detecting the cause of CBD dilatation in patients in whom TUS could not demonstrate the cause of dilation as a proper second step in the diagnostic workup of patients with obstructive jaundice compared to MRCP.

Methods This study was conducted on patients with obstructive jaundice admitted to the inpatient ward or the outpatient endoscopy unit of Theodor Bilharz Research Institute (TBRI) during the period between January 2019 and August 2019.Patient with obstructive jaundice and Abdominal US showed CBD dilatation with internal diameter ≥ 7 mm and biliary stricture.

Results During the period between January 2019 and August 2019, 136 were recruited; 8 were pregnant and 3 patients had gastric bypass surgery were excluded.65 patients were diagnosed confidently by TAU and were excluded from the analysis.60 patients with obstructive jaundice and indefinite etiology on TUS were included in the final analysis.The final diagnosis of patients was 38 patients (63.33 %) of malignant etiology [26 pancreatic cancer (43.33 %), 4 cholangiocarcinoma (6.66 %), and 8 with ampullary cancer (13.33 %)], 22 patients (36.67 %)of benign etiology [10 calcular obstruction (16.66 %), 8 benign stricture (13.33 %),and 4 pancreatitis (6.66 %)].

Tab. 1

Age years, mean (SD)	58.01(11.44)
Sex, male/female n(%)	38/22 (63.3 %: 36.7 %)
T.Bilirubin mg/dL, Median (IQR)	9.00 (6-12)
ALT IU/L, Median (IQR)	53.00 (35.00- 102.50)
ALP U/l, Median (IQR)	301.00 (246.25- 452.25)

The sensitivity and specificity values for malignant stricture detected by EUS were 100 %, 86.36 %, respectively with positive predictive value 92.68 %, negative predictive value 100 % and accuracy 95 %, while MRI showed 82.14 % sensitivity, 25 % specificity with positive predictive value 79.31 and accuracy is 69.4 %.EUS supported correct diagnosis in 57 patients, (95 %: CI 86.08 % to 98.96 %)while MRI did it in 36 patients (69.44 %: CI 51.89 % to 83.65 %).Only 43 (71.7 %) patients needed ERCP for management of obstructive jaundice, sparing 17 patients (28.3 %) unnecessary invasive procedures.

Conclusions EUS is a minimally invasive method with low incidence of complications with high diagnostic accuracy in patients with dilated CBD and normal MRCP.

Citation Abobakr S, Elessawy H, Ghaly S et al. eP394 DIAGNOSTIC ACCURACY OF ENDOSCOPIC ULTRASOUND IN EVALUATION OF PATIENTS WITH OBSTRUCTIVE JAUNDICE: SINGLE CENTER EXPERIENCE. Endoscopy 2021; 53: S225.

Publication History

Article published online:
19 March 2021