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. 1996 Feb;38(2):277–281. doi: 10.1136/gut.38.2.277

Prospective evaluation of endoscopic ultrasonography and microscopic examination of duodenal bile in the diagnosis of cholecystolithiasis in 45 patients with normal conventional ultrasonography.

P Dahan 1, C Andant 1, P Lévy 1, P Amouyal 1, G Amouyal 1, M Dumont 1, S Erlinger 1, A Sauvanet 1, J Belghiti 1, M Zins 1, V Vilgrain 1, P Bernades 1
PMCID: PMC1383037  PMID: 8801211

Abstract

The aim of this study was to prospectively evaluate endoscopic ultrasonography and microscopic examination of duodenal bile in the diagnosis of cholecystolithiasis not detected by conventional ultrasonography. Forty five consecutive patients (26 females, 19 males, mean age: 50 years) with suspected cholecystolithiasis and at least two normal transcutaneous ultrasonography examinations were included. Endoscopic ultrasonographic criteria for the diagnosis of cholecystolithiasis were the presence of stones with or without acoustic shadowing or sludge. Criteria of microscopic examination of bile were cholesterol or bilirubinate crystals or spheroliths. Thirty three patients underwent cholecystectomy and lithiasis was found in gall bladder bile in 24. Twelve patients who were not operated on and were followed up (median: 17 months), had no evidence of cholecystolithiasis. Endoscopic ultrasonography and duodenal bile examination were 96% and 67% sensitive, respectively (p < 0.03). The specificity was not different (86 and 91%, respectively). None of the 16 patients with negative results in both procedures had evidence of cholecystolithiasis. It was found that for the diagnosis of cholecystolithiasis in patients with normal conventional ultrasonography, the sensitivity of endoscopic ultrasonography is higher than that of microscopic examination of duodenal bile. If endoscopic ultrasonography and microscopic examination of duodenal bile are negative, the risk of underdiagnosing cholecystolithiasis is negligible.

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Selected References

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

  1. Abbas A., Baumann R., Schutz J. F., Maillard D., Sondag D., Weill J. P. Cristaux de cholestérol et lithiase biliaire. Intérêt de l'étude de la bile recueillie par tubage duodénal. Gastroenterol Clin Biol. 1984 May;8(5):454–457. [PubMed] [Google Scholar]
  2. Amouyal P., Amouyal G., Lévy P., Tuzet S., Palazzo L., Vilgrain V., Gayet B., Belghiti J., Fékété F., Bernades P. Diagnosis of choledocholithiasis by endoscopic ultrasonography. Gastroenterology. 1994 Apr;106(4):1062–1067. doi: 10.1016/0016-5085(94)90768-4. [DOI] [PubMed] [Google Scholar]
  3. Amouyal P., Palazzo L., Amouyal G., Ponsot P., Mompoint D., Vilgrain V., Gayet B., Fléjou J. F., Paolaggi J. A. Endosonography: promising method for diagnosis of extrahepatic cholestasis. Lancet. 1989 Nov 18;2(8673):1195–1198. doi: 10.1016/s0140-6736(89)91801-1. [DOI] [PubMed] [Google Scholar]
  4. Conrad M. R., Janes J. O., Dietchy J. Significance of low level echoes within the gallbladder. AJR Am J Roentgenol. 1979 Jun;132(6):967–972. doi: 10.2214/ajr.132.6.967. [DOI] [PubMed] [Google Scholar]
  5. Cooperberg P. L., Burhenne H. J. Real-time ultrasonography. Diagnostic technique of choice in calculous gallbladder disease. N Engl J Med. 1980 Jun 5;302(23):1277–1279. doi: 10.1056/NEJM198006053022303. [DOI] [PubMed] [Google Scholar]
  6. Delchier J. C., Benfredj P., Preaux A. M., Metreau J. M., Dhumeaux D. The usefulness of microscopic bile examination in patients with suspected microlithiasis: a prospective evaluation. Hepatology. 1986 Jan-Feb;6(1):118–122. doi: 10.1002/hep.1840060123. [DOI] [PubMed] [Google Scholar]
  7. Goodman A. J., Neoptolemos J. P., Carr-Locke D. L., Finlay D. B., Fossard D. P. Detection of gall stones after acute pancreatitis. Gut. 1985 Feb;26(2):125–132. doi: 10.1136/gut.26.2.125. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Hessler P. C., Hill D. S., Deforie F. M., Rocco A. F. High accuracy sonographic recognition of gallstones. AJR Am J Roentgenol. 1981 Mar;136(3):517–520. doi: 10.2214/ajr.136.3.517. [DOI] [PubMed] [Google Scholar]
  9. JUNIPER K., Jr, BURSON E. N., Jr Biliary tract studies. II. The significance of biliary crystals. Gastroenterology. 1957 Feb;32(2):175-208; discussion, 208-11. [PubMed] [Google Scholar]
  10. Janowitz P., Swobodnik W., Wechsler J. G., Zöller A., Kuhn K., Ditschuneit H. Comparison of gall bladder bile and endoscopically obtained duodenal bile. Gut. 1990 Dec;31(12):1407–1410. doi: 10.1136/gut.31.12.1407. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Kurol M., Forsberg L. Ultrasonography in the diagnosis of acute cholecystitis. Acta Radiol Diagn (Stockh) 1984;25(5):379–383. doi: 10.1177/028418518402500506. [DOI] [PubMed] [Google Scholar]
  12. Lee C. L., Wu C. H., Chen T. K., Lai Y. C., Yang S. S., Huang C. S., Chen D. F. Prospective study of abdominal ultrasonography before laparoscopic cholecystectomy. J Clin Gastroenterol. 1993 Mar;16(2):113–116. doi: 10.1097/00004836-199303000-00007. [DOI] [PubMed] [Google Scholar]
  13. Lee S. P., Nicholls J. F., Park H. Z. Biliary sludge as a cause of acute pancreatitis. N Engl J Med. 1992 Feb 27;326(9):589–593. doi: 10.1056/NEJM199202273260902. [DOI] [PubMed] [Google Scholar]
  14. Marks J. W., Bonorris G. Intermittency of cholesterol crystals in duodenal bile from gallstone patients. Gastroenterology. 1984 Sep;87(3):622–627. [PubMed] [Google Scholar]
  15. McIntosh D. M., Penney H. F. Gray-scale ultrasonography as a screening procedure in the detection of gallbladder disease. Radiology. 1980 Sep;136(3):725–727. doi: 10.1148/radiology.136.3.7403554. [DOI] [PubMed] [Google Scholar]
  16. Neoptolemos J. P., Davidson B. R., Winder A. F., Vallance D. Role of duodenal bile crystal analysis in the investigation of 'idiopathic' pancreatitis. Br J Surg. 1988 May;75(5):450–453. doi: 10.1002/bjs.1800750517. [DOI] [PubMed] [Google Scholar]
  17. Ramond M. J., Dumont M., Belghiti J., Erlinger S. Sensitivity and specificity of microscopic examination of gallbladder bile for gallstone recognition and identification. Gastroenterology. 1988 Nov;95(5):1339–1343. doi: 10.1016/0016-5085(88)90370-8. [DOI] [PubMed] [Google Scholar]
  18. Ros E., Navarro S., Bru C., Garcia-Pugés A., Valderrama R. Occult microlithiasis in 'idiopathic' acute pancreatitis: prevention of relapses by cholecystectomy or ursodeoxycholic acid therapy. Gastroenterology. 1991 Dec;101(6):1701–1709. doi: 10.1016/0016-5085(91)90410-m. [DOI] [PubMed] [Google Scholar]

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