Is EUS with Doppler Comparable to Transabdominal Ultrasond as a Screening Test for Chronic Mesenteric Ischemia (CMI)?

Aims: EUS has been proposed as a single test to evaluate persistent upper abdominal pain. CMI, a potential cause of pain, has not been previously evaluated by EUS. As Doppler flow in the celiac artery (CA) and superior mesenteric artery (SMA) can be measured, we propose that EUS can be used to screen for CMI. Doppler transabominal ultrasound (TUS) is the standard screening test for CMI. Methods: Pts with chronic abdominal pain with suspicion of CMI undergoing either EUS or TUS were reviewed. The peak systolic velocity (PSV) of the CA and SMA were recorded. If MRA was performed, the findings were compared with the values obtained during EUS or TUS. MRA results were considered to be the gold standard when available. Alternatively, a negative TUS and EUS was considered to be an alternative negative gold standard. κ statistics were used to compare the agreement of findings between each modality. Results: 42 pts were included (EUS-38, TUS-24, MRA-22). Doppler measurements of the CA and SMA were successful in 100% and 76% of cases, respectively. EUS and TUS had comparable accuracies evaluating the presence of abnormally elevated flow in the CA and SMA (85% vs. 88%, 96% vs. 95%). EUS and TUS had moderate concordance with MRA. When either the CA or SMA was positive, EUS had a higher sensitivity over TUS (80% vs. 67%) in predicting the presence of stenosis. In addition, 19 EUS examinations yield alternative or additional diagnoses. Discussion: Doppler measurements of the CA and SMA can be obtained during EUS examination. The results suggest that EUS measurements of the CA and SMA are as reliable as TUS when screening for CMI. EUS has an advantage over TUS as it can yield alternative disorders that may be contributing to chronic abdominal pain. EUS with Doppler has the potential to be used as a single comprehensive test in the evaluation of persistent upper abdominal pain.