Fourtyone patients fo gallbladder and bile duct diseases were studied clinically and sonographically.Tweentynine (Seventyone percent) patients were distributed between age fourty to fiftynine and male to femaleratio was 1:1.4. The order of frequency of biliary tract disease was cholelithiasis, acalculous cholecystitis, CBDstone and CBD cancer. Sonographic findings of cholelithiasis were strong echo with posterior shadowing, faintinternal echoes without shadowing, gallbladder wall thickneing and anechoicity of the gallbladder wall. Instead ofsmall proportion of gallbladder distension and wall anechoicity, faint internal echoes without shadowing were seenin ten of nineteen cases of cholelithiasis. On choledocholithiasis, meniscus sign at the junction of the stone andgallbladder wall was identified in most cases and was helpful to differentiation stone from malignancy. The degreeof CBD dilatation was more severe in malignancy than in CBD stones and ascaris in CBD. Sonographic examination wasuseful in detection of gallbladder and bilicary tree pathology and the cause of biliary tract obstruction could beidentified.
Acalculous Cholecystitis ; Ascaris ; Bile Duct Diseases ; Biliary Tract Diseases ; Biliary Tract ; Choledocholithiasis ; Cholelithiasis ; Dilatation ; Gallbladder ; Humans ; Male ; Pathology ; Shadowing (Histology) ; Trees ; Ultrasonography

BACKGROUND/AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) is the most accurate modality in diagnosis of choledocholithiasis. However, it carries some complications. Endoscopic ultrasonography (EUS) is less invasive than ERCP and used for the diagnosis of choledocholithiasis. Recent studies showed that a usefulness of EUS for the diagnosis of small choledocholithiasis without common bile duct (CBD) dilatation. For such a reason, ERCP is being replaced by EUS in the diagnosis of bile duct stones. The aim of this study was to investigate the accuracy of EUS for the diagnosis of choledocholithiasis without CBD dilatation. METHODS: A total of 66 patients with suspected choledocholithiasis without CBD dilatation were enrolled. EUS were performed in all cases within 48 hours after computed tomography (CT) or ultrasonography (US). Final diagnosis was obtained by ERCP or clinical course (minimum 6 months follow-up). We analyzed the accuracy of US, CT, and EUS, respectively. RESULTS: CT and US were performed in 51 and 15 cases, respectively. CBD stones were detected in 23 (35%) patients by ERCP. EUS showed 100% sensitivity, 95% specificity, 92% positive predictive value, and 100% negative predictive value for identifying CBD stones. CT or US showed 26%, 93%, 67%, and 70%, respectively. There were no EUS-related complications. CONCLUSIONS: EUS was more effective than CT or US and as accurate as ERCP for the diagnosis of small choledocholithiasis without CBD dilatation. Thus, EUS may help to avoid unnecessary diagnostic ERCP and its complication.
Adult ; Aged ; Aged, 80 and over ; Choledocholithiasis/pathology/*ultrasonography ; Common Bile Duct Diseases/diagnosis ; Diagnosis, Differential ; Dilatation, Pathologic/diagnosis ; *Endosonography ; Female ; Gallstones/ultrasonography ; Humans ; Male ; Middle Aged ; Sensitivity and Specificity ; Tomography, X-Ray Computed