Diagnostic Significance Of Endoscopic Ultrasonography In Suspected Common Bile Duct Stones

Objective To study on the effectiveness of endoscopic ultrasonography(EUS)in diagnosing suspected common bile duct stones(CBDS).Methods 86 cases of suspected common bile duct stones who had undergone B-ultrasound,CT or MRCP but failed to be diagnosed were selected and analyzed retrospectively.We calculate the incidence of complications,accuracy,positive predictive value and negative predictive value of EUS which was used as a supplementary diagnostic method for the diagnosis of common bile duct stones,and to compare with the previous three imaging examinations.According to the gold standard,the patients were divided into two groups: the stone positive group and the stone negative group.The gold standard is that the results was considered positive when CBDS was found in ERCP,laparoscopic exploration or open bile duct exploration,and when the above check did not find stones,we would follow up for six months,if the patients were not found to have stones,the results was considered negative.The statistical significance of various parameters which could have predictive effects on choledocholithiasis in the two groups of patients were calculated by chi-square test or t-test.Results After the gold standard diagnosis towards the 86 cases of suspected choledocholithiasis,we found that there were 42 patients with positive CBDS,including 13 cases of sediment-like stones,29 cases of non-sediment-like stones,and there were 44 patients with negative CBDS.The clinical manifestation include abdominal pain,jaundice,fever or they were presented as acute pancreatitis,cholangitis.Abdominal pain is the most common symptom,accounting for 91.9% of the patients.The levels of WBC,TP,ALP,GGT,AST and ALT were increased to some degree,and the proportion of the patients whose level of GGT increased is the largest.There was only one false negative patient,and the accuracy of EUS which was used as supplement for patients with suspected choledocholithiasis was 98.8%,and the positive predictive and negative predictive values were 100% and 97.1%.No EUS-related complications were found,and 48.8% of the patients avoid invasive operation of the common bile duct.The mean value of GGT and the percentage of common bile duct dilatation in stone positive group were higher than those in stone negative group,and the difference was statistically significant(P = 0.017,0.004).The mean or difference of age,sex,the time between other image examination and EUS,image examination of our hospital,symptoms and other laboratory tests between the two groups was not statistically significant.Conclusion EUS was a safe and efficient complementary diagnostic tool for patients with suspected choledocholithiasis who have undergone one or more of B-ultrasound,CT or MRCP,and 48.8% of the patients avoid invasive operation of the common bile duct.Patients who have dilated common bile duct and elevated GGT are more likely to have common bile duct stones,but they still need further diagnosis of EUS.