Abstract
Background and Study Aims: It is becoming increasingly evident from a number of studies that endoscopic ultrasound
(EUS) is much more sensitive in the diagnosis of cholecystitis than transabdominal
ultrasound (TUS). The present study was undertaken to further evaluate this relative
sensitivity.
Patients and Methods: Sixty-six patients with biliary-type pain and a negative transabdominal ultrasound
examination underwent combined endoscopic ultrasound and stimulated biliary drainage
(EUS/SBD). Stimulated biliary drainage was obtained following intraduodenal infusion
of magnesium sulfate or intravenous sincalide, a CCK analogue. EUS was considered
positive if sludge or small stones were seen in the gallbladder. Stimulated biliary
drainage was considered positive if calcium bilirubinate granules or cholesterol crystals
were seen on microscopic examination of aspirated bile.
Results: At operation, 61 of the patients had cholecystitis documented histologically. Fifty-eight
of the patients had gallbladder sludge or small stones on EUS. One patient had a negative
EUS, but had calcium bilirubinate granules in the bile. Twenty-one patients were followed
post-operatively for a period of seven to 17 months, with an average of 10.5 months.
Nineteen patients (90.5 %) remain free of biliary pain.
Conclusions: Combined endoscopic ultrasound and stimulated biliary drainage (EUS/SBD) had a high
sensitivity of 92.4 % and a positive predictive value of 100 % in the diagnosis of
cholecystitis when transabdominal ultrasound was negative. A significant majority
(90.5 %) of patients with positive EUS/SBD who underwent cholecystectomy had resolution
of their biliary pain.
