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© 2007 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 26:455-460 • 0278-4297

Role of Endoscopic Ultrasonography in Prevention of Unnecessary Endoscopic Retrograde Cholangiopancreatography

A Prospective Study of 150 Patients

Rasoul Sotoudehmanesh, MD, Shadi Kolahdoozan, MD, Ali Ali Asgari, MD, Masoud Dooghaei-Moghaddam, MD and Sanaz Ainechi, MD

Digestive Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Address correspondence to Rasoul Sotoudehmanesh, MD, Shariati Hospital, Endoscopic Ultrasonography Ward, North Kargar, Tehran 14117-13135, Iran. E-mail: setoodeh{at}ams.ac.ir

Objective. The purpose of this study was to evaluate the impact of substituting endoscopic ultrasonography (EUS) for endoscopic retrograde cholangiopancreatography (ERCP) in cases of a low to intermediate risk for choledocholithiasis. Methods. During a 16-month period, patients who were referred for suspected choledocholithiasis, biliary colic, or acute biliary pancreatitis on the basis of alterations in liver enzyme values with or without gallstones seen on transabdominal ultrasonography were included. Endoscopic ultrasonography was performed for all patients. Patients with common bile duct stones underwent ERCP. Cholecystectomy was recommended in all patients with symptomatic gallstones. Cases were followed for 12 months. Results. A total of 150 patients were included. Choledocholithiasis was diagnosed by EUS in 39 patients (26.0%) and was confirmed by ERCP in 30 (77.0%). Fifty-one patients had a normal common bile duct, and follow-up for 12 months showed no abnormalities except in 1 patient. Cholecystectomy without ERCP was recommended for the remaining 60 patients who had symptomatic gallstones or sludge. Endoscopic retrograde cholangiopancreatography was avoided by this approach in 110 patients (73.3%). Conclusions. In a low to intermediate risk for choledocholithiasis, EUS can preclude the need for ERCP in most cases.

Key Words: choledocholithiasis • endoscopic retrograde cholangiography • endoscopic ultrasonography

Abbreviations: CBD, common bile duct • CT, computed tomographic • ERCP, endoscopic retrograde cholangiopancreatography • EUS, endoscopic ultrasonography • TUS, transabdominal ultrasonography

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Copyright © 2007 by the American Institute of Ultrasound in Medicine.