Division of Gastroenterology, Department of Internal Medicine, Tungs' Taichung Metroharbor Hospital, Taichung, Taiwan, ROC.
J Chin Med Assoc. 2012 Jun;75(6):251-4. doi: 10.1016/j.jcma.2012.04.006. Epub 2012 May 15.
Radial endoscopic ultrasound (EUS) is a less invasive imaging modality used to evaluate common bile duct stones (CBDS) and is as accurate as endoscopic retrograde cholangiography (ERCP). Patients classified as high risk for suspected CBDS were found to have stones in only two-thirds of cases, and an argument could be made for performing EUS in these high-risk patients. There are very few reports of linear EUS for CBDS detection. Our aim was to evaluate the diagnostic efficiency of linear EUS in patients with suspected CBDS in intermediate- and high-risk groups.
This is a retrospective analysis of prospectively collected data for 30 patients with suspected CBDS assessed using linear EUS. The inclusion criteria were acute epigastric pain, abnormal liver function test (LFT), and CBDS not detected by transabdominal ultrasound or computed tomography. The exclusion criteria were failure to insert a linear EUS endoscope into the duodenum and Billroth II gastrectomy. ERCP was performed in patients with positive CBDS on linear EUS. Cases with negative CBDS after linear EUS examination were followed in terms of clinical symptoms and LFT for at least for 3 months as outpatients.
There were 17 male and 13 female patients with a mean age of 53 (±17.6) years. Twelve cases were positive for CBDS, of which 11 were confirmed by ERCP and one was a false positive. In cases with negative CBDS on linear EUS, the median follow-up duration was 9 (3-12) months. The overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 100%, 94.7%, 91.7%, 100%, and 96.7%, respectively. CBDS was positive in 56% (9/16) of high-risk patients and 14.3% (2/14) of intermediate-risk patients.
Linear EUS is sensitive for the detection of CBDS. It detected 56% of CBDS in a high-risk group and 14.2% in an intermediate-risk group and therefore is a useful assessment tool in patients with high or intermediate risk of CBDS.
径向内镜超声（EUS）是一种侵袭性较小的成像方式，用于评估胆总管结石（CBDS），其准确性与内镜逆行胰胆管造影（ERCP）相当。对于被认为有 CBDS 高危的患者，只有三分之二的患者被发现有结石，因此对于这些高危患者，可以考虑进行 EUS 检查。关于 CBDS 检测的线性 EUS 报道很少。我们的目的是评估线性 EUS 在中高危 CBDS 患者中的诊断效率。
这是一项对 30 例经线性 EUS 评估的疑似 CBDS 患者的前瞻性数据进行的回顾性分析。纳入标准为急性上腹痛、肝功能检查（LFT）异常和经腹部超声或计算机断层扫描未发现 CBDS。排除标准为未能将线性 EUS 内镜插入十二指肠和 Billroth II 胃切除术。对线性 EUS 检查发现 CBDS 阳性的患者进行 ERCP。对线性 EUS 检查阴性的病例，在门诊至少随访 3 个月，观察临床症状和 LFT。
患者 17 例为男性，13 例为女性，平均年龄为 53（±17.6）岁。12 例 CBDS 阳性，其中 11 例经 ERCP 证实，1 例为假阳性。在线性 EUS 阴性的病例中，中位随访时间为 9（3-12）个月。总体敏感性、特异性、阳性预测值、阴性预测值和准确性分别为 100%、94.7%、91.7%、100%和 96.7%。高危患者中 CBDS 阳性率为 56%（9/16），中危患者中为 14.3%（2/14）。
线性 EUS 对 CBDS 的检测具有较高的敏感性。它在高危组中检出了 56%的 CBDS，在中危组中检出了 14.2%的 CBDS，因此是一种有用的 CBDS 高危或中危患者的评估工具。
