Linear EUS for bile duct stones

Background: Radial scanning endoscopic ultrasonography (EUS) has been shown , in experienced hands, to be a safe and accurate means of detecting bile d uct stones. We compared linear array EUS with endoscopic retrograde cholang iopancreatography (ERCP), in our first 50 cases, to evaluate efficacy of th is examination as well as the learning curve for this indication. Methods: A retrospective study was conducted on 50 patients with suspected choledocholithiasis. We compared results of EUS with those of ERCP as a ref erence. First a linear EUS examination was performed followed by ERCP, at a median interval of 31 days (range 3 to 162 days). Results: The average age of patients was 56 years (range 26 to 76); 48% wer e women. Fifteen (30%) had undergone cholecystectomy, a mean of 8.5 years ( range 1 to 22) before the EUS. EUS compared with ERCP had a 97% sensitivity , 77% specificity, and 90% accuracy. In 14% of patients EUS provided an add itional or alternative diagnosis: chronic pancreatitis (n = 3), duodenitis (2), bile duct stricture (1), chronic gastritis (1). No complications were encountered due to EUS. Conclusions: We found in this early experience that linear array EUS is a r easonably safe and accurate means of detecting choledocholithiasis. Linear array EUS, despite the learning curve, seems to be about equivalent to radi al EUS in accuracy. Appropriate use of this less invasive technique may pos sibly replace the use of diagnostic ERCP.