Endoscopic Ultrasonography Detects Cholelithiasis in Patients with Biliary Colic and Negative Transabdominal Ultrasonography

Objective: To evaluate the efficacy and sensitivity of endoscopic ultrasonography (EUS) for detecting gallstones in patients with biliary colic and negative transabdominal ultrasonography (TUS).

Methods: We prospectively studied 89 consecutive patients referred because of biliary colic and at least one normal TUS examination. EUS was performed with a mechanical radial scanning echo-endoscope (Olympus GF-MU 160). Patients with cholelithiasis on EUS were offered medical therapy, cholecystectomy, or observation.

Results: EUS was performed on 89 consecutive patients (mean age, 46 yr; range, 19–85 yr; sex, 24M/65F). By EUS, cholelithiasis and microlithiasis were identified in 72 patients (81%) and 6 patients (7%), respectively (total 88%). Ten of 72 patients (14%) with cholelithiasis and 1 of 6 patients (17%) with microlithiasis were lost to follow-up. At follow-up visits, in 44 of 62 patients (71%) with cholelithiasis who underwent laparoscopic cholecystectomy, 40 (91%) had complete resolution of biliary colic. Four patients (9%) who underwent surgery had no change in symptoms. Four of 18 patients who did not have surgery treated with Ursodiol become asymptomatic. In 11 of 14 patients (79%) biliary colic persisted. Three of 14 patients (21%) without any therapy also become asymptomatic. Of 5 patients with microlithiasis, One of 2 who underwent surgery became symptom-free and the another the symptoms persisted. One continued to have symptoms without treatment, and 2 became asymptomatic without treatment.

Conclusions: In patients with biliary colic and negative transabdominal ultrasonography, EUS is a useful diagnostic modality to detect cholelithiasis and these patients are likely to benefit from cholecystectomy. Moreover, biliary colic is a good predictor of cholelithiasis and/or microlithiasis on EUS.