[Pragmatic diagnostic value of hepatobiliary echography in 193 consecutive jaundiced patients referred to an endoscopic retrograde cholangiography center].

The aim of this retrospective work was to study the reliability of hepatobiliary sonography (SG) in a population of 193 icteric patients referred to our endoscopic retrograde cholangiography pancreatography (ERCP) unit between January 1980 and January 1983. One hundred and eight patients were female (ages varying from 9 to 90 years, average: 61 years) and 85 were male (ages varying from 9 to 91 years, average: 55 years). This study's objective was purely pragmatic. The initial SG report served as a basis for assessment of the diagnostic value of ultrasound examination. According to the sonographic patterns observed (biliary dilatation or not), jaundice was classified as intra- or extrahepatic. The sonographic results were then compared to the definitive diagnosis as determined from clinical, biological and pathological data. In the case of an obstacle, the final diagnosis was confirmed by either ERCP or laparotomy. When ERCP showed no obstruction, the final diagnosis was based on either percutaneous hepatic biopsy or clinical and biological evolution and in two cases, an autopsy findings. In this population and considering the pragmatic context of the study, the effectiveness of SG in classifying jaundice as extra- or intrahepatic was 76 p. 100 (70-82), the sensitivity was 75 p. 100 (67-83), specificity, 81 p. 100 (72-89), positive predictive value, 87 p. 100 (81-93) and the negative predictive value, 66 p. 100 (56-76). Sixty-seven p. 100 of the 30 false negative diagnoses in 120 cases of obstructive jaundice corresponded to misdiagnosis of cholelithiasis. SG was able to suggest the etiology of jaundice in 94 cases; this was correct in 58 cases (61 p. 100).(ABSTRACT TRUNCATED AT 250 WORDS)