Endoscopic sonography in the diagnosis of gallbladder wall lesions in patients with gallstones

Purpose. The purpose of this study was to evaluate the diagnostic accuracy of endoscopic sonography (EUS) in the detection of gallbladder wall lesions in patients with and without gallstones. Methods. We retrospectively reviewed the medical records, sonograms, and so nographic reports of 62 patients who underwent cholecystectomy for gallblad der wall lesions evaluated by EUS. We assessed the accuracy of EUS in diagn osing gallbladder wall lesions in the presence or absence of gallstones and on the basis of the size and number of stones and the size of the gallblad der wall lesions. We also evaluated the effect of acoustic shadowing. The E US results were compared with the histopathologic results. Results. EUS correctly diagnosed the gallbladder wall lesions in 17 (71%) o f 24 patients with gallstones and in 34 (89%) of 38 patients without gallst ones. The diagnostic accuracy of EUS was 86% in patients with gallbladder w all lesions smaller than 20 mm and 79% in patients with gallbladder wall le sions 20 mm or larger. The diagnostic accuracy was 75% in patients with gal lstones smaller than 5 mm and 67% in patients with stones 5 mm or larger. T he accuracy was 67% in patients with 1-5 stones and 83% in patients with 6 or more stones. None of these differences was statistically significant. Ac oustic shadowing did not affect the diagnostic accuracy of EUS. Conclusions. The diagnostic accuracy of EUS for gallbladder wall lesions is not affected by the presence of gallstones. However, better diagnostic cri teria must be established based on larger studies, and technical refinement s of the equipment are needed to increase the accuracy of EUS in the diagno sis of gall-bladder wall lesions. (C) 2001 John Wiley & Sons, Inc.