Effectiveness of Endoscopic Ultrasonography in the Diagnosis of Choledocholithiasis Prior to Laparoscopic Cholecystectomy

Abstract

Background and Study Aims: To reduce the rate of conversion to open cholecystectomy, and to avoid retained bile duct stones, it is essential to detect choledocholithiasis prior to laparoscopic cholecystectomy. The aim of the present study was to evaluate the usefulness and safety of performing endoscopic ultrasonography (EUS) for the diagnosis of choledocholithiasis prior to laparoscopic cholecystectomy.

Patients and Methods: One hundred thirty-two patients with symptomatic cholelithiasis were evaluated prospectively using standard abdominal ultrasonography (US), US plus EUS, and US plus endoscopic retrograde cholangiography (ERC) for the detection of choledocholithiasis prior to laparoscopic cholecystectomy.

Results: Twenty-eight patients (21.2 %) had choledocholithiasis, and six patients with common bile duct stones had normal-sized ducts on US. The common bile duct was successfully examined in all patients using EUS, but only in 65.9 % of patients when US was used and 94.7 % of patients when ERC was used. US plus EUS detected choledocholithiasis in 25 of 28 patients (89.3 %), US in 19 of 28 patients (67.9 %), and US plus ERC in 26 of 28 patients (92.9 %). While no complications as a result of EUS were encountered, complications resulting from ERC occurred in seven patients (5.3 %), including cholecystitis in two patients, cholangitis in three patients, and pancreatitis in two patients. In view of the complication and failure rates, EUS appears to offer significant advantages over ERC. These results suggest that EUS is more sensitive than standard abdominal ultrasonography, and as sensitive as ERC.

Conclusions: EUS appears to be as sensitive as, and safer than, ERC in the detection of choledocholithiasis prior to laparoscopic cholecystectomy.