Prospective evaluation of early endoscopic ultrasonography for triage in suspected choledocholithiasis: results from a large single centre series.
BACKGROUND
Endoscopic ultrasonography is accurate, safe, and cost-effective in diagnosing common bile duct stones, thus suggesting the possibility to avoid invasive endoscopic retrograde cholangiopancreatography.


AIM
To prospectively evaluate the diagnostic and therapeutic performance of early endoscopic ultrasonography in suspected choledocholithiasis.


PATIENTS AND METHODS
All consecutive patients presenting to the Emergency Department with suspicion of choledocholithiasis between January 2010 and January 2012 were evaluated and categorized as low, moderate, or high probability of choledocholithiasis, according to accepted criteria. Endoscopic endosonography was carried out within 48 h from the admission and endoscopic retrograde cholangiopancreatography was performed soon in case of confirmed choledocholithiasis.


RESULTS
Overall 179 patients were included: 48 (26.8%) were classified as low, 65 (36.3%) as moderate, and 66 (36.9%) as high probability of choledocholithiasis. Of the 86 patients with common bile duct stones at endoscopic endosonography, endoscopic retrograde cholangiopancreatography confirmed the finding in 79 (92%). By multivariate analysis only the common bile duct diameter proved an independent predictor of common bile duct stones.


CONCLUSIONS
Early endoscopic endosonography is accurate in identifying choledocholithiasis allowing immediate endoscopic treatment and significant spare of unnecessary endoscopic retrograde cholangiopancreatography. This approach can be useful as a triage test to select patients not needing endoscopic retrograde cholangiopancreatography, allowing, in selected cases, their early discharge.
['Anderloni|Andrea|A|', 'Ballarè|Marco|M|', 'Pagliarulo|Michela|M|', 'Conte|Dario|D|', 'Galeazzi|Marianna|M|', 'Orsello|Marco|M|', 'Andorno|Silvano|S|', 'Del Piano|Mario|M|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D002760:Cholangiopancreatography, Endoscopic Retrograde D042883:Choledocholithiasis D015331:Cohort Studies D003135:Common Bile Duct D042241:Early Diagnosis D019160:Endosonography D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D015999:Multivariate Analysis D011446:Prospective Studies D012680:Sensitivity and Specificity D014218:Triage
Endoscopic ultrasonography Choledocholithiasis ERCP