PROSPECTIVE EVALUATION OF ENDOSCOPIC ULTRASONOGRAPHY AND MICROSCOPIC EXAMINATION OF DUODENAL BILE IN THE DIAGNOSIS OF CHOLECYSTOLITHIASIS IN 45 PATIENTS WITH NORMAL CONVENTIONAL ULTRASONOGRAPHY

The aim of this study was to prospectively evaluate endoscopic ultraso nography and microscopic examination of duodenal bile in the diagnosis of cholecystolithiasis not detected by conventional ultrasonography. Forty five consecutive patients (26 females, 19 males, mean age: 50 ye ars) with suspected cholecystolithiasis and at least two normal transc utaneous ultrasonography examinations were included. Endoscopic ultras onographic criteria for the diagnosis of cholecystolithiasis were the presence of stones with or without acoustic shadowing or sludge. Crite ria of microscopic examination of bile were cholesterol or bilirubinat e crystals or spheroliths. Thirty three patients underwent cholecystec tomy and lithiasis was found in gall bladder bile in 24. Twelve patien ts who were not operated on and were followed up (median: 17 months), had no evidence of cholecystolithiasis. Endoscopic ultrasonography and duodenal bile examination were 96% and 67% sensitive, respectively (p <0.03). The specificity was not different (86 and 91%, respectively). None of the 16 patients with negative results in both procedures had e vidence of cholecystolithiasis. It was found that for the diagnosis of cholecystolithiasis in patients with normal conventional ultrasonogra phy, the sensitivity of endoscopic ultrasonography is higher than that of microscopic examination of duodenal bile. If endoscopic ultrasonog raphy and microscopic examination of duodenal bile are negative, the r isk of underdiagnosing cholecystolithiasis is negligible.