COMBINED ENDOSCOPIC ULTRASOUND AND STIMULATED BILIARY DRAINAGE IN CHOLECYSTITIS AND MICROLITHIASIS - DIAGNOSES AND OUTCOMES

Background and Study Aims: It is becoming increasingly evident from a number of studies that endoscopic ultrasound (EUS) is much more sensit ive in the diagnosis of cholecystitis than transabdominal ultrasound ( TUS). The present study was undertaken to further evaluate this relati ve sensitivity. Patients and Methods: Sixty-six patients with biliary- type pain and a negative transabdominal ultrasound examination underwe nt combined endoscopic ultrasound and stimulated biliary drainage (EUS /SBD). Stimulated biliary drainage was obtained following intraduodena l infusion of magnesium sulfate or intravenous sincalide, a CCK analog ue, EUS was considered positive if sludge or small stones were seen in the gallbladder. Stimulated biliary drainage was considered positive if calcium bilirubinate granules or cholesterol crystals were seen on microscopic examination of aspirated bile. Results: At operation, 61 o f the patients had cholecystitis documented histologically. Fifty-eigh t of the patients had gallbladder sludge or small stones on EUS. One p atient had a negative EUS, but had calcium bilirubinate granules in th e bile, Twenty-one patients were followed postoperatively for a period of seven to 17 months, with an average of 10.5 months. Nineteen patie nts (90.5%) remain free of biliary pain. Conclusions: Combined endosco pic ultrasound and stimulated biliary drainage (EUS/SBD) had a high se nsitivity of 92.4% and a positive predictive value of 100% in the diag nosis of cholecystitis when transabdominal ultrasound was negative, A significant majority (90.5%) of patients with positive EUS/SBD who und erwent cholecystectomy had resolution of their biliary pain.