Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
Department of Ultrasonography, Shengjing Hospital of China Medical University, Shenyang, China.
BMC Gastroenterol. 2022 Jun 27;22(1):318. doi: 10.1186/s12876-022-02394-8.
The purpose of this retrospective study aimed to assess the accuracy of detection of remnant common bile duct (CBD) stones by injecting saline through endoscopic nasobiliary drainage (ENBD) tubes under transabdominal ultrasound (US) guidance.
Stone extraction and ENBD are regularly achieved through endoscopic retrograde cholangiopancreatography (ERCP) in patients with CBD stones. At 1-3 days thereafter, routine US studies were performed and repeated, using ENBD tubal saline injections (20-100 mL).
A total of 302 patients underwent standard ERCP stone extractions in conjunction with occlusion cholangiograms, routine US testing, and ENBD-based saline-injection US exams. By occlusion cholangiogram, remnant stones were suspected in 31 (10.3%) patients in total of 302, and 26 (83.8%) were verified as true positives (sensitivity, 50.9%; specificity, 98.0%). Routine US studies proved suspicious in 13 (4.3%) patients in total of 302, and 12 (92.3%) were verified as true positives (sensitivity, 23.5%; specificity, 99.6%). Using ENBD-based saline-injection US, suspected stones were identified in 50 (16.6%) patients in total of 302, and 46 (92%) were verified as true positives (sensitivity, 90.1%; specificity, 98.4%). The sensitivity of ENBD-based saline-injection US significantly surpassed that of occlusion cholangiogram (p < 0.001) and routine US (p < 0.001).
Detection of remnant CBD stones via ENBD-based saline-injection US is a valid, inexpensive, and repeatable means of patient screening that is non-invasive, radiation-free, and dynamically informative. This may help improve the accuracy of detecting remnant CBD stones after ERCP.
本回顾性研究旨在评估经腹部超声（US）引导下通过内镜鼻胆管引流（ENBD）管注入盐水检测残余胆总管（CBD）结石的准确性。
对于 CBD 结石患者，常规通过内镜逆行胰胆管造影术（ERCP）进行取石和 ENBD。此后 1-3 天，通过 ENBD 管盐水注射（20-100ml）进行常规 US 检查并重复。
共有 302 例患者接受了标准 ERCP 取石术，同时进行了闭塞胆管造影、常规 US 检查和基于 ENBD 的盐水注射 US 检查。通过闭塞胆管造影，302 例患者中共有 31 例（10.3%）疑似残余结石，其中 26 例（83.8%）被证实为阳性（敏感性 50.9%，特异性 98.0%）。常规 US 检查在 302 例患者中总共有 13 例（4.3%）疑似阳性，其中 12 例（92.3%）被证实为阳性（敏感性 23.5%，特异性 99.6%）。使用基于 ENBD 的盐水注射 US，302 例患者中总共有 50 例（16.6%）疑似结石，其中 46 例（92%）被证实为阳性（敏感性 90.1%，特异性 98.4%）。基于 ENBD 的盐水注射 US 的敏感性明显高于闭塞胆管造影（p<0.001）和常规 US（p<0.001）。
经 ENBD 管注入盐水的超声检测残余 CBD 结石是一种有效、经济、可重复、非侵入性、无辐射且具有动态信息的患者筛查方法。这可能有助于提高 ERCP 后检测残余 CBD 结石的准确性。
