Napoléon B, Dumortier J, Keriven-Souquet O, Pujol B, Ponchon T, Souquet J-C
Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Lyon, France.
Endoscopy. 2003 May;35(5):411-5. doi: 10.1055/s-2003-38778.
Biliary endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiography (ERC) are equally accurate for the diagnosis of common bile duct (CBD) stone. The aim of this prospective 1-year follow-up study was to determine whether normal findings at initial EUS obviated the need for ERC.
During a 17-month period, all patients referred for biliary EUS because of suspicion of CBD stone, in whom EUS findings were normal were included in the study. Early (1-month) and late (1-year) follow-up details were obtained by mail or telephone. The clinical course and need for ERC were recorded.
238 patients were enrolled. During follow-up, 59 (25 %) patients underwent cholecystectomy, with (n=31) or without (n=28) cholangiography, and 30 patients underwent ERC (13 %). CBD stone was found in 14 (6 %) patients. Of these 30 patients, ERC was done in 15 cases in the first week after EUS, because of persistent suspicion of a CBD stone which was found in 10 patients. The 15 late ERC procedures (carried out more than 1 week after EUS) revealed only one CBD stone. The negative predictive value of EUS for the diagnosis of CBD stones was 95.4 %.
Patients with suspicion of CBD stones but normal EUS findings have a low risk of needing ERC in a 1-year period.
胆管内镜超声检查（EUS）和内镜逆行胰胆管造影（ERC）在诊断胆总管（CBD）结石方面准确性相当。这项前瞻性1年随访研究的目的是确定初次EUS检查结果正常是否可避免进行ERC。
在17个月期间，所有因怀疑CBD结石而接受胆管EUS检查且EUS检查结果正常的患者均纳入本研究。通过邮件或电话获取早期（1个月）和晚期（1年）随访详情。记录临床病程及进行ERC的必要性。
共纳入238例患者。随访期间，59例（25%）患者接受了胆囊切除术，其中31例进行了胆管造影，28例未进行；30例患者接受了ERC（13%）。14例（6%）患者发现有CBD结石。在这30例患者中，15例在EUS检查后第一周内进行了ERC，原因是持续怀疑有CBD结石，其中10例患者被发现有结石。15例晚期ERC手术（在EUS检查1周后进行）仅发现1例CBD结石。EUS对诊断CBD结石的阴性预测值为95.4%。
怀疑有CBD结石但EUS检查结果正常的患者在1年内需要进行ERC的风险较低。
