Park Jae Keun, Lee Jong Kyun, Yang Ju Il, Lee Keol, Park Joo Kyung, Lee Kwang Hyuck, Lee Kyu Taek
a Department of Medicine , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea.
Scand J Gastroenterol. 2018 Oct-Nov;53(10-11):1381-1387. doi: 10.1080/00365521.2018.1524021. Epub 2018 Dec 5.
The American Society for Gastrointestinal Endoscopy (ASGE) guidelines offered the risk-stratified approach in suspected choledocholithiasis. Previous studies have raised concern about the insufficient accuracy of the guideline, especially in high probability group. The purposes of this study were to authenticate the stratification and clinical predictors of the guidelines for suspected choledocholithiasis with no visible choledocholithiasis on computed tomography (CT) and to make clear the clinical strategy of endoscopic ultrasonography (EUS).
We carried out the retrospective single-center study of 156 patients with suspected choledocholithiasis but negative findings on CT who underwent EUS for about 8 years at Samsung Medical Center. We assessed the clinical predictors of the ASGE guidelines in predicting the presence of choledocholithiasis and the outcome of the EUS.
Fifty-three of the 156 patients had positive findings on EUS that included choledocholithiasis (n = 43, 27.6%) or obstructive papillitis (n = 10, 6.4%). Among the 53 patients, 51 (96.2%) had choledocholithiasis or obstructive papillitis on ERCP. The 101 patients of 103 patients with negative finding on EUS did not show biliary events during follow-up period. EUS accuracy was 98.7% (sensitivity 100%; specificity 98.1%). Among the 49 patients with high probability, 21 (42.9%) had choledocholithiasis on ERCP. In 107 patients who were classified as intermediate probability, 30 (27.3%) had choledocholithiasis. There were no complications related to EUS.
Not only intermediate probability group but also high probability group without definite acute cholangitis may require EUS. Application of EUS for suspected choledocholithiasis is highly accurate, safe and reduces unnecessary invasive ERCP in 57.1% of patients with high probability group.
美国胃肠内镜学会（ASGE）指南针对疑似胆总管结石提出了风险分层方法。既往研究对该指南准确性不足表示担忧，尤其是在高概率组中。本研究旨在验证针对CT上未见胆总管结石的疑似胆总管结石患者的指南分层及临床预测因素，并明确内镜超声（EUS）的临床策略。
我们对三星医疗中心约8年间156例疑似胆总管结石但CT检查结果为阴性且接受EUS检查的患者进行了回顾性单中心研究。我们评估了ASGE指南在预测胆总管结石存在及EUS结果方面的临床预测因素。
156例患者中53例EUS检查结果为阳性，包括胆总管结石（n = 43，27.6%）或梗阻性乳头炎（n = 10，6.4%）。在这53例患者中，51例（96.2%）在ERCP检查中发现胆总管结石或梗阻性乳头炎。EUS检查结果为阴性的103例患者中有101例在随访期间未出现胆道事件。EUS的准确性为98.7%（敏感性100%；特异性98.1%）。在49例高概率患者中，21例（42.9%）在ERCP检查中发现胆总管结石。在107例被归类为中度概率的患者中，30例（27.3%）发现胆总管结石。未发生与EUS相关的并发症。
不仅中度概率组，而且无明确急性胆管炎的高概率组患者可能都需要进行EUS检查。EUS用于疑似胆总管结石检查具有高度准确性、安全性，且可减少57.1%高概率组患者不必要的侵入性ERCP检查。
