Symptom Resolution or Relief after Cholecystectomy Correlates Strongly with Positive Combined Endoscopic Ultrasound and Stimulated Biliary Drainage

Abstract

Background and study aims: Combined endoscopic ultrasound and stimulated biliary drainage (EUS/SBD) has been shown to have better sensitivity than transabdominal ultrasonography (TUS) in the diagnosis of subtle gallbladder disease. The aim of the present study was to obtain long-term postoperative outcome data on a group of patients diagnosed by EUS/SBD.

Patients and methods: Eighty-one patients underwent cholecystectomy for biliary pain after negative TUS findings (except for gallbladder sludge in three cases), but with positive EUS/SBD findings. EUS/SBD was performed as previously reported, with a positive result defined as gallbladder sludge or small stones noted on EUS or a positive biliary drainage. Clinical outcome data were obtained by phone an average of 15.4 months postoperatively.

Results: All 81 patients had a positive EUS/SBD, and all underwent cholecystectomy. Seventy-six of the patients (93.8 %) had abnormal gallbladder histopathology. It was possible to contact 80 patients an average of 15.4 months postoperatively (range of 7-27 months). Seventy patients (87.5 %) remained free of biliary pain, and in seven (8.8 %) the symptoms had improved.

Conclusion: When EUS/SBD results are positive, this correlates strongly with long-term symptom resolution or relief (96.3 %) after cholecystectomy. EUS/SBD demonstrated better sensitivity (93.8 %) than TUS in diagnosing subtle gallbladder disease.