Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, South Korea.
Dig Dis Sci. 2012 Dec;57(12):3246-51. doi: 10.1007/s10620-012-2261-x. Epub 2012 Jun 23.
Choledocholithiasis commonly occurs in patients with symptomatic cholelithiasis. Although the recently developed multidetector computed tomography (MDCT) scan enhances the ability to diagnose choledocholithiasis, this technique is considered to have some limitations for evaluating the common bile duct (CBD).
The purpose of this study was to evaluate the necessity for performing endoscopic ultrasound (EUS) as an add-on test to detect choledocholithiasis in patients who were diagnosed with gallstone disease without choledocholithiasis based on MDCT.
Three hundred twenty patients with gallstone disease and no evidence of CBD stones according to MDCT underwent EUS between March 2006 and April 2011. If CBD stones were suspected based on the EUS results or clinical symptoms, a final diagnosis was obtained by endoscopic retrograde cholangiopancreatography (ERCP). The patients' medical records were retrospectively analyzed based on clinical symptoms, biochemical findings, and results of the imaging studies.
CBD stones were not detected with MDCT in 41 (12.8 %) out of 320 patients with gallstone disease. The causes for these discrepancies could be attributed to small stone size (n = 19, 46.3 %), isodensity (n = 18, 43.9 %), impacted stones (n = 1, 2.4 %), and misdiagnosis (n = 3, 7.3 %). If EUS were used as a triage tool, unnecessary diagnostic ERCP and its complications could be avoided for 245 (76.6 %) patients.
MDCT may not be a primary technique for detecting CBD stones. EUS should be performed instead as an add-on test to evaluate the CBD for patients with gallstone-related disease. In particular, EUS should be routinely recommended for patients with abnormal liver enzyme levels, pancreatitis, and dilated CBD.
胆总管结石常发生于有症状的胆石症患者中。尽管最近开发的多排螺旋 CT（MDCT）扫描提高了诊断胆总管结石的能力，但该技术被认为在评估胆总管（CBD）方面存在一些局限性。
本研究旨在评估在 MDCT 诊断为胆石症而无胆总管结石的患者中，为了发现胆总管结石而行内镜超声（EUS）作为附加检查的必要性。
2006 年 3 月至 2011 年 4 月，320 例胆石症且 MDCT 未见 CBD 结石的患者接受了 EUS 检查。如果根据 EUS 结果或临床症状怀疑 CBD 结石，则通过内镜逆行胰胆管造影（ERCP）获得最终诊断。回顾性分析这些患者的病历，依据临床症状、生化检查和影像学研究结果进行分析。
320 例胆石症患者中，41 例（12.8%）MDCT 未发现 CBD 结石。导致这种差异的原因可能是结石较小（n = 19，46.3%）、等密度（n = 18，43.9%）、嵌顿结石（n = 1，2.4%）和误诊（n = 3，7.3%）。如果将 EUS 作为一种分诊工具，可避免 245 例（76.6%）患者进行不必要的诊断性 ERCP 及其并发症。
MDCT 可能不是检测 CBD 结石的主要技术。应将 EUS 作为附加检查用于评估 CBD，用于有胆石症相关疾病的患者。特别是对于肝酶水平异常、胰腺炎和 CBD 扩张的患者，应常规推荐 EUS。
