Unsal Belkıs, Alper Emrah, Baydar Behlül, Aslan Fatih, Akpinar Zehra, Buyraç Zafer, Aksöz Mehmet Kadir
Department of, Gastroenterology, Atatürk Training and Research Hospital, İzmir.
Turk J Gastroenterol. 2011 Feb;22(1):54-9. doi: 10.4318/tjg.2011.0157.
BACKGROUND/AIMS: The diagnostic value of endoscopic ultrasound in common bile duct stones is high. In this investigation, we evaluated the feasibility of endoscopic ultrasound preceding endoscopic retrograde cholangiography in the same session and the potential benefits in increasing the therapeutic endoscopic retrograde cholangiography ratio in the treatment of choledocholithiasis.
One hundred and sixty-five consecutive patients who presented with elevated ALP and bilirubin levels and were referred for endoscopic retrograde cholangiography of biliary stones diagnosed with magnetic resonance cholangiopancreatography were evaluated. During the evaluation period (mean: 2 weeks), 50 patients with reductions in ALP and bilirubin by at least half relative to baseline values were enrolled into the study. Endoscopic ultrasound was performed prior to endoscopic retrograde cholangiography. Time spent to perform endoscopic ultrasound was noted. For the presence of common bile duct stone, we used retrograde cholangiography findings as the standard of reference.
Median endoscopic ultrasound time was 10.66 minutes (SD±1.52). Bile duct stones were revealed with retrograde cholangiography in 34 patients (68%). Sensitivity, specificity (with 95% confidence intervals [CIs]), positive predictive value and negative predictive value of endoscopic ultrasound were calculated. In identifying common bile duct stones on endoscopic ultrasound, sensitivity, specificity, positive predictive value, and negative predictive value were statistically determined as 91.2% (95% CI), 88.3% (95% CI), 91%, and 81.3%, respectively.
Our results indicate that in the presence of local experience and availability of endoscopic ultrasound, it is feasible to perform endoscopic ultrasound prior to endoscopic retrograde cholangiography. The sensitivity, specificity, positive predictive value, and negative predictive value for detecting choledocholithiasis in suspected cases are high. Endoscopic ultrasound preceding endoscopic retrograde cholangiography in the same session has the potential to decrease diagnostic endoscopic retrograde cholangiography and increase therapeutic endoscopic retrograde cholangiography. Need to perform magnetic resonance cholangiopancreatography in the presence of easily accessible endoscopic ultrasound should be questioned.
背景/目的：内镜超声对胆总管结石具有较高的诊断价值。在本研究中，我们评估了在同一次诊疗过程中先进行内镜超声检查再进行内镜逆行胰胆管造影（ERCP）的可行性，以及在胆总管结石治疗中提高治疗性ERCP比例的潜在益处。
对165例因碱性磷酸酶（ALP）和胆红素水平升高而前来就诊、经磁共振胰胆管造影诊断为胆管结石并被转诊进行ERCP的连续患者进行评估。在评估期（平均2周）内，将50例ALP和胆红素水平相对于基线值至少降低一半的患者纳入研究。在ERCP之前进行内镜超声检查。记录进行内镜超声检查所花费的时间。对于胆总管结石的存在，我们将逆行胆管造影结果作为参考标准。
内镜超声检查的中位时间为10.66分钟（标准差±1.52）。34例患者（68%）经逆行胆管造影发现胆管结石。计算了内镜超声的敏感性、特异性（95%置信区间[CI]）、阳性预测值和阴性预测值。在内镜超声检查中识别胆总管结石时，敏感性、特异性、阳性预测值和阴性预测值经统计学确定分别为91.2%（95%CI）、88.3%（95%CI）、91%和81.3%。
我们的结果表明，在内镜超声检查具备当地经验且可开展的情况下，在ERCP之前进行内镜超声检查是可行的。在疑似病例中检测胆总管结石的敏感性、特异性、阳性预测值和阴性预测值都很高。在同一次诊疗过程中先进行内镜超声检查再进行ERCP有可能减少诊断性ERCP，并增加治疗性ERCP。在容易获得内镜超声检查的情况下是否需要进行磁共振胰胆管造影值得质疑。
