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Al-Azhar Assiut Medical Journal
Al-Azhar University, Faculty of Medicine, Assiut
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Abstract: |
ABSTRACT :
Background and Aim:
Accurate procedures for recognizing common bile duct (CBD) and pancreatic conditions are
essential to manage proper interventions. We aimed to assess the utility of endoscopic
ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP) in discovering
CBD stones compared to endoscopic retrograde cholangiopancreatography (ERCP).
Patients and Methods:
This prospective multicenter study included 200 patients over 18 years old with dilated CBD
measuring 6-10 mm, unexplained elevated liver enzymes (ALT more than 55 U/L, AST more
than 48 U/L), and unexplained acute pancreatitis (amylase elevated more than 86 U/L, and
lipase elevated more than 59 U/L, respectively). The patients were evaluated using abdominal
ultrasonography, MRCP, and EUS. MRCP is performed just before the EUS and the ERCP
being performed at a subsequent stage whenever indicated.
Results:
Stones were discovered in 39.5% of the patients using ERCP compared to 47% using MRCP
and 43.5% using EUS. There was a strong agreement between ERCP findings and EUS
findings (Kappa=0.837). EUS can notably distinguish stones with a sensitivity of 94.9%,
specificity of 90.1%, positive predictive value (PPV) of 86.2%, Negative predictive value
(NPV) of 96.5%, and accuracy of 92%. There was a moderate agreement between ERCP
findings and MRCP findings (Kappa=0.402). MRCP can significantly detect stones with a
sensitivity of 72.2%, specificity of 69.4%, PPV of 60.6%, NPV of 79.2%, and accuracy of
70.5%. The accuracy of EUS was significantly higher than accuracy of MRCP.
Conclusions:
EUS is a more accurate diagnostic device for detecting stones compared to MRCP, and it has
a strong agreement with ERCP findings, which is considered the gold standard.
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