Skip to main content
NCBI home page
Gut logoLink to Gut
. 1992 Nov;33(11):1559–1561. doi: 10.1136/gut.33.11.1559

Value of ultrasound and liver function tests in determining the need for endoscopic retrograde cholangiopancreatography in unexplained abdominal pain.

J R Thornton 1, A J Lobo 1, D J Lintott 1, A T Axon 1
PMCID: PMC1379546  PMID: 1452084

Abstract

The value of serum liver function tests and abdominal ultrasound as screening tests of the need for endoscopic retrograde cholangiopancreatography (ERCP) was determined in patients with unexplained abdominal pain without associated jaundice. In 1989 and 1990 1005 ERCPs were undertaken, of which 138 (14%) were for this indication. The duct or ducts of interest were delineated by ERCP in 95% of patients. The lesions found were bile duct stones in 10 patients, chronic pancreatitis in five, pancreatic carcinoma in one, peptic ulcer or duodenitis in four. A satisfactory ultrasound examination had been performed in 94% of patients. For chronic pancreatitis, its sensitivity was 60% and specificity 95%. For choledocholithiasis, the ultrasonic detection of duct dilatation or stones had a sensitivity of 90% and specificity of 86%. Of the liver function tests, the alkaline phosphatase was more sensitive (67%) than the transaminases (44%) in indicating the presence of bile duct stones and had a high specificity (95%). None of the 10 patients with duct stones had normal ultrasound and normal alkaline phosphatase. Thus it was found that demonstration of a normal common bile duct by abdominal ultrasound and normal serum alkaline phosphatase together have 100% specificity in excluding bile duct stones. Using such knowledge over the two year period of this study would have spared 36 patients the need for ERCP.

Full text

PDF
1559

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bull J., Keeling P. W., Thompson R. P. Endoscopic retrograde cholangiopancreatography for unexplained upper abdominal pain. Br Med J. 1980 Mar 15;280(6216):764–764. doi: 10.1136/bmj.280.6216.764. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Foster P. N., Mitchell C. J., Robertson D. R., Hamilton I., Irving H., Kelleher J., Lintott D. J., Robinson P. J., Axon A. T., Losowsky M. S. Prospective comparison of three non-invasive tests for pancreatic disease. Br Med J (Clin Res Ed) 1984 Jul 7;289(6436):13–16. doi: 10.1136/bmj.289.6436.13. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Gibson R. N., Yeung E., Thompson J. N., Carr D. H., Hemingway A. P., Bradpiece H. A., Benjamin I. S., Blumgart L. H., Allison D. J. Bile duct obstruction: radiologic evaluation of level, cause, and tumor resectability. Radiology. 1986 Jul;160(1):43–47. doi: 10.1148/radiology.160.1.3520654. [DOI] [PubMed] [Google Scholar]
  4. Laing F. C., Jeffrey R. B., Jr, Wing V. W., Nyberg D. A. Biliary dilatation: defining the level and cause by real-time US. Radiology. 1986 Jul;160(1):39–42. doi: 10.1148/radiology.160.1.3012631. [DOI] [PubMed] [Google Scholar]
  5. Lindsell D. R. Ultrasound imaging of pancreas and biliary tract. Lancet. 1990 Feb 17;335(8686):390–393. doi: 10.1016/0140-6736(90)90217-s. [DOI] [PubMed] [Google Scholar]
  7. Tobin M. V., Mendelson R. M., Lamb G. H., Gilmore I. T. Ultrasound diagnosis of bile duct calculi. Br Med J (Clin Res Ed) 1986 Jul 5;293(6538):16–17. doi: 10.1136/bmj.293.6538.16. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Wastell C. Laparoscopic cholecystectomy. BMJ. 1991 Feb 9;302(6772):303–304. doi: 10.1136/bmj.302.6772.303. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES