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2014 ; 14
(57
): 125-9
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Choledocholithiasis diagnostics - endoscopic ultrasound or endoscopic retrograde
cholangiopancreatography?
#MMPMID26672977
Leszczyszyn J
J Ultrason
2014[Jun]; 14
(57
): 125-9
PMID26672977
show ga
It is estimated that 3.4% of patients qualified for cholecystectomy due to
cholelithiasis have a coexisting choledocholithiasis. For decades, endoscopic
ascending retrograde cholangiopancreatography has been the golden diagnostic
standard in cases of suspected choledocholithiasis. The method is associated with
a relatively high rate of complications, including acute pancreatitis, the
incidence of which is estimated to range between 0.74% and 1.86%. The mechanism
of this ERCP-induced complication is not fully understood, although factors
increasing the risk of acute pancreatitis, such as sphincter of Oddi dysfunction,
previous acute pancreatitis, narrow bile ducts or difficult catheterization of
Vater's ampulla are known. It has been suggested to discontinue the diagnostic
endoscopic retrograde ascending cholangiopancreatography and replace it with
endoscopic ultrasonography due to possible and potentially dangerous
complications. Endoscopic ultrasonography has sensitivity of 94% and specificity
of 95% regardless of gallstone diameter, as opposed to magnetic resonance
cholangiography. However, both of these parameters depend on the experience of
the performing physician. The use of endoscopic ultrasonography allows to limit
the number of performed endoscopic retrograde cholangiopancreatography procedures
by more than 2/3. Ascending endoscopic retrograde cholangiopancreatography
combined with an endoscopic incision into the Vater's ampulla followed by a
mechanical evacuation of stone deposits from the ducts still remains a golden
standard in the treatment of choledocholithiasis. Despite some limitations such
as potentially increased treatment costs as well as the necessity of the
procedure to be performed by a surgeon experienced in both endoscopic retrograde
cholangiopancreatography as well as endoscopic ultrasonography, the diagnostic
endoscopic ultrasonography followed by a simultaneous endoscopic retrograde
cholangiopancreatography aimed at gallstone removal is the most efficient
diagnostic and therapeutic management scheme in cases of suspected
choledocholithiasis.
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