DIAGNOSIS OF CHOLEDOCHOLITHIASIS BY ENDOSCOPIC ULTRASONOGRAPHY

Background/Aims: Endoscopic ultrasonography is a promising procedure f or the diagnosis of extrahepatic cholestasis. Accuracy for the diagnos is of choledocholithiasis by ultrasonography and computed tomography w ere prospectively compared with endoscopic ultrasonography in 62 conse cutive patients. Methods: Final diagnosis was determined by endoscopic retrograde cholangiography with or without sphincterotomy or intraope rative cholangiography with or without choledochoscopy. All of the pat ients had abdominal ultrasonography, computed tomography, endoscopic u ltrasonography, and either an endoscopic retrograde (n = 40) or intrao perative cholangiography (n = 32) performed. Results: Choledocholithia sis was confirmed in 22 patients. Thirteen patients had a stone with a diameter <1 cm, and 14 had a nonenlarged common bile duct. Endoscopic ultrasonography was more sensitive (97%) than ultrasonography (25%; P < 0.0001) and computed tomography (75%; P < 0.02). Specificity and po sitive predictive value were not significantly different. Negative pre dictive value of endoscopic ultrasonography (97%) was better than that of ultrasonography (56%; P < 0.0001) and computed tomography (78%; P < 0.02). Results were unchanged after six patients in whom the absence of choledocholithiasis was considered probable after follow-up were e xcluded. Endoscopic ultrasonography results did not depend on stone di ameter or common bile duct dilatation. Conclusions: Endoscopic ultraso nography appears to be the best diagnostic tool for the diagnosis of c holedocholithiasis compared with other noninvasive procedures.