EUS in diagnosis of choledocholithiasis

Background and study aims. In 38-80% patients with suspicion to choledocholithiasis were no stones in CBD after ERCP. ERCP is not safe procedure and has a risk of complications ranging 4-15%. The aim of our study was to estimate the diagnostic value and safety of EUS in CBD stones diagnosis.Patients and methods. In patients with low or medium probability of CBD stones (i.e. CBD < 10 mm and/or bilirubin < 2 times upper normal) was performed linear EUS. From September 2012 till December 2013 it were 40 investigations. Results. After EUS CBD stones were revealed in 11 patients. Average stone size was 5,6±3,3 (2-12) mm. ERCP was performed in 10 of them. Stones were confirmed and removed in 9 of 10 patients, in one patient without stones it was found a stricture of terminal part of CBD. In 4 patients absence of stones was confirmed during laparoscopic cholecystectomy with IOC. Patients without indications to cholecystectomy were followed for six months and there were no additional investigations.It were no complications after EUS. EUS sensitivity was 100%, specificity - 96,7%, PPV - 90%, NPV - 100%.Conclusion. EUS is effective tool for diagnosis of CBD stones in patients with medium and low probability of choledocholithiasis. It could be recommended as a first diagnostic step because the risk of complications is negligible.