Ang T L, Teo E K, Fock K M
Division of Gastroenterology, Department of Medicine, Changi General Hospital, Singapore.
Aliment Pharmacol Ther. 2007 Oct 15;26(8):1163-70. doi: 10.1111/j.1365-2036.2007.03463.x.
Endosonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) are highly accurate techniques for evaluating common bile duct stones.
To compare the clinical impact and costs of EUS- and ERCP-based strategies for evaluating patients with suspected common bile duct stones but normal transabdominal imaging.
The costs of EUS- vs. ERCP-based strategies were compared in patients with suspected acute biliary obstruction from common bile duct stones but normal transabdominal imaging.
Over a 15-month period, 110 patients were recruited. EUS detected a common bile duct lesion in 73% (common bile duct stones: 68%; pancreatic cancer: 2%; ampulla tumour: 2%; cholangiocarcinoma: 1%). The sensitivity, specificity, positive predictive value and negative predictive value of EUS were 98%, 100%, 100% and 93%, respectively. EUS prevented 30% unnecessary ERCP. The mean difference in cost per patient between EUS- and ERCP-based strategies was US$166. When stratified according to clinical indications, an EUS-based strategy was costlier only in suspected biliary sepsis. Costs were similar when the indications were cholestatic jaundice, acute pancreatitis and cholestasis.
EUS prior to biliary interventions in patients with suspected common bile duct stones prevented unnecessary ERCP. It allowed a definitive diagnosis to be made prior to more invasive procedures.
内镜超声检查（EUS）和内镜逆行胰胆管造影（ERCP）是评估胆总管结石的高度准确的技术。
比较基于EUS和ERCP的策略对疑似胆总管结石但腹部超声成像正常的患者进行评估的临床影响和成本。
对疑似因胆总管结石导致急性胆道梗阻但腹部超声成像正常的患者，比较基于EUS与ERCP的策略的成本。
在15个月的时间里，招募了110名患者。EUS检测到胆总管病变的比例为73%（胆总管结石：68%；胰腺癌：2%；壶腹肿瘤：2%；胆管癌：1%）。EUS的敏感性、特异性、阳性预测值和阴性预测值分别为98%、100%、100%和93%。EUS避免了30%不必要的ERCP。基于EUS和ERCP的策略每位患者的平均成本差异为166美元。根据临床指征分层时，仅在疑似胆源性脓毒症中基于EUS的策略成本更高。当指征为胆汁淤积性黄疸、急性胰腺炎和胆汁淤积时，成本相似。
对于疑似胆总管结石的患者，在进行胆道干预之前进行EUS可避免不必要的ERCP。它允许在进行更具侵入性的手术之前做出明确诊断。
