Endoscopy 2006; 39 - WE15
DOI: 10.1055/s-2006-947628

Role of endoscopic ultrasound in the evaluation of postsphincterotomy extrahepatic biliary dysorders in cholecystectomized patients

D Dajèman 1, M Skalicky 1, P Skok 1, C Pernat 1, D Æeraniæ 1, D Urlep 1, M Pocajt 1
  • 1Clinical Department for Internal medicine, Teaching Hospital, Maribor, SI

Introduction: Postsphincterotomy problems in cholecystectomized patients include a heterogenous group of diseases, usually manifested by abdominal pain, jaudice or other symptoms following endoscopic sphincterotomy (EST) and gallblader removal. These patients are in endoscopic unit first assessed by transabdominal ultrasound (TUS), followed by endoscopic cholangiography (ERC). Less invasive and cost-effective diagnostic alternatives with similar capabilities are endoscopic ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP).

Aims & Methods: The aim of our study was to prospectively assess the role of clinical algorithm that included EUS instead ERC and represent our diagnostic guidelines. Another ERC was performed as a function of the EUS results. With knowledge of the end diagnosis, the probable evaluation and outcomes were reassessed that ERC would have been performed after TUS. We included 78 cholecystectomized and sphincterotomized patients with billiary problems admitted in our department during a period 36 months, from september 2002 to end of august 2005. End diagnosis was confirmed by a combination of clinical and laboratory findings, with endoscopic and ultrasound imaging.

Results: The study group consisted of 31 males and 47 females, while end diagnosis included common bile duct stones, insufficient cholecystectomy, cystic duct remnant or chronic pancreatitis. After TUS all patients underwent to EUS on Olympus EUS GF UM 20 and a 7.5MHz ultrasound probe with 360o rotation followed by ERC. The sensitivity and specificity of EUS findings were high in the subgroup of 46 patients (22 males and 24 females) with common bile duct stones (96.7% and 89.2%). Moreover, EUS had a high negative predictive value of 93.2%.

Conclusion: Algoritmic approach which include EUS for the initial evaluation of the cholecystectomized patients after EST with billiary problems is a precise method for diagnostic of recidival common bile duct stones and can decrease number of diagnostic ERC. Such diagnostic and therapeutic guidelines can be save and low-cost promising goal for patients which can be treat as fast as possible by the same endoscopic team.