TRANSABDOMINAL ULTRASOUND: A POTENTIALLY ACCURATE AND USEFUL TOOL FOR DETECTION OF CHOLEDOCHOLITHIASIS

Zainab Zahur, Asif Jielani, Tatheer Fatima, Aness Ahmad

Abstract


Background: Choledocholithiasis denotes to the presence of gallstones within the common bile duct. In patients with Gall stones, the precise incidence and prevalence of choledocholithiasis are not known, but it has been estimated that 5 to 20 percent of patients have choledocholithiasis at the time of cholecystectomy, with the incidence increasing with age. The transabdominal ultrasound examination (US) is the most commonly used modality for symptoms attributable to gallstone disease. US can provide important evidence for presence of stones in CBD. Methods: This was a descriptive cross-sectional validation study which was conducted at PAEC General Hospital, Islamabad from February to July 2015. Patients with suspected choledocholithiasis attending radiology department for ultrasound abdomen were included in the study. Findings for dilatation of common bile duct, intrahepatic biliary channel dilatation and direct visualization of calculus in CBD were noted. Ultrasound findings were compared with subsequent ERCP which was considered gold standard. Results: Diagnostic accuracy of trans abdominal ultrasound in detection of choledocholithiasis came out to be 76.9% with sensitivity of 76.2% and specificity of 81.3%. Conclusion: Ultrasound can be used as an initial and baseline tool for detection of CBD calculi as it is non-invasive, easily available, radiation free and cost effective.

Keywords: Choledocholithiasis; Trans abdominal ultrasound; Endoscopic retrograde cholangiopancreatography; diagnostic accuracy

References


Ghazanfar S, Qureshi S, Leghari A, Taj MA, Niaz SK, Quraishy MS. Endoscopic balloon sphincteroplasty as an adjunct to endoscopic sphincterotomy in removing large and difficult bile duct stones. J Pak Med Assoc 2010;60(12):1039–42.

Unsal B, Alper E, Baydar B, Aslan F, Akpinar Z, Buyraç Z, et al. Combined use of endosonography and endoscopic retrograde cholangiopancreatography in the same session. Turk J Gastroenterol 2011;22(1):54–9.

Tozzi di Angelo I, Prochazka V, Holinka M, Zapletalova J. Endosonography versus endoscopic retrograde cholangiopancreatography in diagnosing extrahepatic biliary obstruction. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2011;155(4):339–46.

Pickuth D, Spielmann RP. Detection of choledocholithiasis: comparison of unenhanced spiral CT, US, and ERCP. Hepatogastroenterology 2000;47(36):1514–7.

Magalhães J, Rosa B, Cotter J. Endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis: From guidelines to clinical practice. World J Gastrointest Endosc. 2015 Feb 16;7(2):128-34.

Simonen P, Gylling H, Miettinen T. Body weight modulates cholesterol metabolism in non-insulin dependent type 2 diabetics. Obes Res. 2002 May;10(5):328-35.

Schirmer BD, Winters KL, Edlich RF. Cholelithiasis and cholecystitis. J Long Term Eff Med Implants 2005;15(3):329–38.

Riciardi R, Islam S, Canete JJ, Arcand PL, Stoker ME. Effectiveness and long-term results of laparoscopic common bile duct exploration. Surg Endosc 2003;17(1):19–22.

Metcalfe MS, Ong T, Bruening MH, Iswariah H, Wemyss-Holden SA, Maddern GJ. Is laparoscopic intraoperative cholangiogram a matter of routine? Am J Surg 2004;187(4):475–81.

Schafmayer C, Hartleb J, Tepel J, Albers S, Freitag S, Völzke H, et al. Predictors of gallstone composition in 1025 symptomatic gallstones from Northern Germany. BMC Gastroenterol. 2006 Nov 22;6:36.

Marschall HU, Einarsson C. Gallstone disease. J Intern Med 2007;261(6):529–42.

Habib L, Mirza MR, Ali Channa M, Wasty W. Role of liver function tests in symptomatic cholelithiasis. J Ayub Med Coll Abbottabad 2009;21(2):117–9.

Freitas ML, Bell RL, Duffy AJ. Choledocholithiasis: Evolving standards for diagnosis and management. World J Gastroenterol 2006;12(20):3162–7.

Prachayakul V, Aswakul P, Bhunthumkomol P, Deesomsak M. Diagnostic yield of endoscopic ultrasonography in patients with intermediate or high likelihood of choledocholithiasis: a retrospective study from one university-based endoscopy center. BMC Gastroenterol 2014;14:165.

Stott MA, Farrands PA, Guyer PB, Dewbury KC, Browning JJ, Sutton R. Ultrasound of the common bile duct in patients undergoing cholecystectomy. J Clin Ultrasound 1991;19(2):73–6.

Einstein DM, Lapin SA, Ralls PW, Halls JM. The insensitivity of sonography in the detection of choledocholithiasis. AJR Am J Roentgenol 1984;142(4):725–8.

Kim CW, Chang JH, Lim YS, Kim TH, Lee IS, Han SW. Common bile duct stones on multidetector computed tomography: attenuation patterns and detectability. World J Gastroenterol 2013;19(11):1788–96.

Kaltenthaler EC, Walters SJ, Chilcott J, Blakeborough A, Vergel YB, Thomas S. MRCP compared to diagnostic ERCP for diagnosis when biliary obstruction is suspected: a systematic review. BMC Med Imaging 2006;6:9.

van Santvoort HC, Bakker OJ, Besselink MG, Bollen TL, Fischer K, Nieuwenhuijs VB, et al. Prediction of common bile duct stones in the earliest stages of acute biliary pancreatitis. Endoscopy 2011;43(1):8–13.


Refbacks

  • There are currently no refbacks.


Contact Number: +92-992-382571

email: [jamc] [@] [ayubmed.edu.pk]