Choledocholithiasis diagnostics - endoscopic ultrasound or XXXX ?

@entity1 @entity788 @entity1690 @entity10747 @entity5990 @entity2963 @entity2877
It is estimated that 3.4% of @entity1 qualified for cholecystectomy due to @entity2963 have a coexisting @entity2877 . For decades, endoscopic ascending retrograde cholangiopancreatography has been the golden diagnostic standard in cases of suspected @entity2877 . The method is associated with a relatively high rate of complications, including acute @entity788 , 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 @entity788 , such as @entity1690 , previous acute @entity788 , 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 @entity5990 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 @entity10747 procedures by more than 2/3. Ascending @entity10747 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 @entity2877 . 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 @entity10747 as well as endoscopic ultrasonography, the diagnostic endoscopic ultrasonography followed by a simultaneous @entity10747 aimed at @entity5990 removal is the most efficient diagnostic and therapeutic management scheme in cases of suspected @entity2877 .
