Wehrmann T, Martchenko K, Riphaus A
Department of Gastroenterology, Deutsche Klinik für Diagnostik, Wiesbaden, Germany.
Endoscopy. 2009 Feb;41(2):133-7. doi: 10.1055/s-0028-1103491. Epub 2009 Feb 12.
Endoscopic ultrasonography (EUS) has been established as a valuable diagnostic tool for the detection of bile duct stones (BDS). The recently introduced extraductal endoscopic ultrasonography (EDUS) using miniprobes has the advantage that it can be performed with a duodenoscope, and if therapeutic interventions become necessary, there is no need to change the scope.
Consecutive patients with acute biliary pain and a dilated bile duct and/or elevated liver function tests, in whom the origin of biliary obstruction could not be identified by US and CT, were enrolled. The patients were investigated with a linear-array echoendoscope, and an additional transduodenal EDUS examination was performed with a 12-MHz miniprobe via the instrumentation channel of the echoendoscope. The presence or absence of BDS was afterwards evaluated by endoscopic retrograde cholangiopancreatography (ERCP)/sphincterotomy (EST) and by instrumental bile duct exploration (in the case of a positive EUS/EDUS finding), or by magnetic resonance cholangiopancreatography (MRCP) and ERCP with additional clinical follow-up (in the case of negative findings on EUS/EDUS).
One hundred and fifty-five patients (55 +/- 12 years old, 98 female) were enrolled. In six cases, the distal bile duct could not be successfully visualized by EDUS, whereas with EUS visualization failed in only one patient ( P = 0.13). Choledocholithiasis was proven in 75 cases (48 %). The diagnostic accuracy of EUS for the detection of BDS (sensitivity 92 %, specificity 100 %, PPV 1.0, NPV 0.93, accuracy 95 %) was comparable to that of EDUS (sensitivity 90 %, specificity 98 %, PPV 0.99, NPV 0.93, accuracy 91 %, P = 0.17 vs. EUS).
In patients at intermediate risk of BDS it seems to be justified to perform EDUS instead of EUS, and to proceed with ERCP and EST immediately when findings are positive.
内镜超声检查（EUS）已成为检测胆管结石（BDS）的一种有价值的诊断工具。最近推出的使用微型探头的导管外内镜超声检查（EDUS）具有可以通过十二指肠镜进行检查的优势，并且如果需要进行治疗干预，则无需更换内镜。
纳入连续的急性胆绞痛患者，这些患者胆管扩张和/或肝功能检查结果升高，且超声（US）和计算机断层扫描（CT）无法确定胆道梗阻的病因。患者接受线阵超声内镜检查，并通过超声内镜的器械通道使用12兆赫微型探头进行额外的经十二指肠EDUS检查。之后通过内镜逆行胰胆管造影（ERCP）/括约肌切开术（EST）以及器械胆管探查（如果EUS/EDUS检查结果为阳性）来评估是否存在BDS，或者通过磁共振胰胆管造影（MRCP）和ERCP以及额外的临床随访（如果EUS/EDUS检查结果为阴性）来评估。
共纳入155例患者（年龄55±12岁，女性98例）。6例患者的远端胆管无法通过EDUS成功观察到，而EUS检查中只有1例患者观察失败（P = 0.13）。75例（48%）患者被证实患有胆总管结石。EUS检测BDS的诊断准确性（敏感性92%，特异性100%，阳性预测值1.0，阴性预测值0.93，准确性95%）与EDUS相当（敏感性90%，特异性98%，阳性预测值0.99，阴性预测值0.93，准确性91%，与EUS相比P = 0.17）。
对于BDS中度风险的患者，似乎有理由进行EDUS而非EUS检查，并且当检查结果为阳性时立即进行ERCP和EST。
