Canto M I, Chak A, Stellato T, Sivak M V
Department of Medicine (Gastroenterology), University Hospitals of Cleveland-Case Western Reserve University, Ohio, USA.
Gastrointest Endosc. 1998 Jun;47(6):439-48. doi: 10.1016/s0016-5107(98)70242-1.
Choledocholithiasis is a major source of morbidity among patients undergoing cholecystectomy for symptomatic gallstones. There is no consensus on the best approach to diagnosing bile duct stones. We compared the safety, accuracy, diagnostic yield, and cost of EUS- and ERCP-based approaches.
Sixty-four consecutive pre- and post-cholecystectomy patients referred for endoscopic retrograde cholangiopancreatography (ERCP) for suspected choledocholithiasis were prospectively evaluated in a blinded fashion. All were stratified into risk groups using predefined criteria. Endoscopic ultrasonography (EUS) and ERCP were sequentially performed by two endoscopists.
The success rates of EUS and ERCP were 98% and 94%, respectively. The accuracy of EUS for diagnosing choledocholithiasis was 94%. EUS provided an additional or alternative diagnosis to bile duct stones in 21% of patients. The complication rate of EUS was significantly lower than diagnostic ERCP. An EUS-based strategy costs less than diagnostic ERCP in patients with low, moderate, or intermediate risk.
EUS is comparably accurate, but safer and less costly than ERCP for evaluating patients with suspected choledocholithiasis. It is useful in patients with an increased risk of having common bile duct stones based on clinical criteria and those with contraindications for or prior unsuccessful ERCP. EUS may enable selective performance of ERCP and improve the cost-effectiveness of diagnosing choledocholithiasis.
胆总管结石是有症状胆结石患者行胆囊切除术时发病的主要原因。对于胆管结石的最佳诊断方法尚无共识。我们比较了基于超声内镜（EUS）和内镜逆行胰胆管造影（ERCP）方法的安全性、准确性、诊断率及成本。
连续64例因疑似胆总管结石而接受内镜逆行胰胆管造影（ERCP）检查的胆囊切除术前及术后患者，以盲法进行前瞻性评估。所有患者均使用预定义标准分层为风险组。由两名内镜医师依次进行内镜超声检查（EUS）和ERCP。
EUS和ERCP的成功率分别为98%和94%。EUS诊断胆总管结石的准确性为94%。EUS为21%的患者提供了胆管结石的额外或替代诊断。EUS的并发症发生率显著低于诊断性ERCP。对于低、中或中度风险患者，基于EUS的策略成本低于诊断性ERCP。
对于评估疑似胆总管结石的患者，EUS的准确性相当，但比ERCP更安全且成本更低。对于根据临床标准胆总管结石风险增加的患者以及有ERCP禁忌证或既往ERCP不成功的患者，EUS很有用。EUS可使ERCP选择性进行，并提高胆总管结石诊断的成本效益。
