Urgent ERCP has been advocated in patients (pts) with gallstone pancreatitis but it only appears to benefit pts with stones in the common bile duct (CBD). EUS has been shown to be accurate in diagnosing common bile duct stones and may allow one to be selective in performing ERCP. AIM: To investigate the potential of EUS in evaluating the gallbladder, common bile duct, and pancreas of pts with suspected biliary pancreatitis. METHODS: Patients admitted with suspected gallstone pancreatitis were prospectively studied at two centers. EUS was performed immediately prior to ERCP, within 72 hours of admission. The endosonographer was blinded to all details of patient history and the biliary endoscopist was blinded to results of the EUS. RESULTS: Seventeen pts (12 women, mean age 44 years) were entered into the study. Pts had a mean serum amylase of 1492 U/l (range, 346 to 4654) on admission. Only 4 (27%) of the pts had CBD stones, and all underwent endoscopic extraction. EUS was 100% accurate in evaluating the presence or absence of stones in the CBD. Endoscopic cholangiography was falsely positive in 3 pts (small stones interpreted, but no stones extracted post sphincterotomy) and falsely negative in 1 pt (cholangiogram negative but stone extracted post sphincterotomy). Thirteen pts had intact gallbladders. The gallbladder could not be imaged by transcutaneous US in 1 obese pt and by EUS in the other 2 pts. In the remaining 10 pts, US and EUS were 100% concordant in their interpretation of the gallbladder (9 pts had cholelithiasis, 1 did not). Imaging of the pancreas by EUS demonstrated peripancreatic fluid in 3 pts, including the only 2 pts with moderately severe pancreatitis. The third patient had cholecystitis and required open cholecystectomy. CONCLUSIONS: 1. EUS can evaluate the gallbladder and CBD accurately in patients with suspected gallstone pancreatitis; 2. EUS is as accurate as ERCP in diagnosing CBD stones; and 3. Presence of peripancreatic fluid on EUS may prove to be prognostically useful. Because EUS can accurately determine etiology and is also able to select pts for endoscopic stone extraction, we propose EUS as the best initial diagnostic test in pts with suspected gallstone pancreatitis.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging