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Article: Comparison of EUS and ERCP in the investigation with suspected biliary obstruction caused by choledocholithiasis: a randomized study
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TitleComparison of EUS and ERCP in the investigation with suspected biliary obstruction caused by choledocholithiasis: a randomized study
 
AuthorsLee, YT1
Chan, FKL1
Leung, WK1
Chan, HLY1
Wu, JCY1
Yung, MY1
Ng, EKW1
Lau, JYW1
Sung, JJY1
 
Issue Date2008
 
PublisherMosby, Inc. The Journal's web site is located at http://www.elsevier.com/locate/gie
 
CitationGastrointestinal Endoscopy, 2008, v. 67 n. 4, p. 660-668 [How to Cite?]
DOI: http://dx.doi.org/10.1016/j.gie.2007.07.025
 
AbstractBackground: EUS may be used to reduce the need of diagnostic ERCP. Objective: Our purpose was to investigate the benefits and safety of an EUS-guided versus an ERCP-guided approach in the management of suspected biliary obstructive diseases caused by choledocholithiasis, in whom a US study is not diagnostic. Design: A randomized study. Setting: A university medical unit. Patients: Patients with clinical, biochemical, or radiologic suspicion of biliary obstruction. Interventions: In the EUS group, therapeutic ERCP was performed at the same EUS session if a lesion was found. In the ERCP group, therapeutic treatment was carried out at the discretion of the endoscopist. Main Outcome Measurements: The number of ERCPs avoided, procedure-related complications, and recurrent biliary symptoms on follow-up at 1 year. Results: Thirty-three patients were randomized to EUS and 32 to ERCP. Three patients (9.4%) had failed ERCPs, whereas all EUS procedures were successful. Nine (27.3%) patients in the EUS group were found to have biliary lesions that were all treated by ERCP. In the ERCP group, 7 (22%) patients had biliary lesions detected that were treated in the same session. More patients had serious complications (bleeding, acute pancreatitis, and umbilical abscess) in the ERCP group. One patient in each group had recurrent biliary symptoms during follow-up. With EUS used as a triage tool, diagnostic ERCP and its related complications could be spared in 49 (75.4%) patients. Conclusions: In patients suspected to have biliary obstructive disease, EUS is a safe and accurate test to select patients for therapeutic ERCP. © 2008 American Society for Gastrointestinal Endoscopy.
 
ISSN0016-5107
2013 Impact Factor: 4.900
 
DOIhttp://dx.doi.org/10.1016/j.gie.2007.07.025
 
ReferencesReferences in Scopus
 
DC FieldValue
dc.contributor.authorLee, YT
 
dc.contributor.authorChan, FKL
 
dc.contributor.authorLeung, WK
 
dc.contributor.authorChan, HLY
 
dc.contributor.authorWu, JCY
 
dc.contributor.authorYung, MY
 
dc.contributor.authorNg, EKW
 
dc.contributor.authorLau, JYW
 
dc.contributor.authorSung, JJY
 
dc.date.accessioned2012-09-05T05:28:12Z
 
dc.date.available2012-09-05T05:28:12Z
 
dc.date.issued2008
 
dc.description.abstractBackground: EUS may be used to reduce the need of diagnostic ERCP. Objective: Our purpose was to investigate the benefits and safety of an EUS-guided versus an ERCP-guided approach in the management of suspected biliary obstructive diseases caused by choledocholithiasis, in whom a US study is not diagnostic. Design: A randomized study. Setting: A university medical unit. Patients: Patients with clinical, biochemical, or radiologic suspicion of biliary obstruction. Interventions: In the EUS group, therapeutic ERCP was performed at the same EUS session if a lesion was found. In the ERCP group, therapeutic treatment was carried out at the discretion of the endoscopist. Main Outcome Measurements: The number of ERCPs avoided, procedure-related complications, and recurrent biliary symptoms on follow-up at 1 year. Results: Thirty-three patients were randomized to EUS and 32 to ERCP. Three patients (9.4%) had failed ERCPs, whereas all EUS procedures were successful. Nine (27.3%) patients in the EUS group were found to have biliary lesions that were all treated by ERCP. In the ERCP group, 7 (22%) patients had biliary lesions detected that were treated in the same session. More patients had serious complications (bleeding, acute pancreatitis, and umbilical abscess) in the ERCP group. One patient in each group had recurrent biliary symptoms during follow-up. With EUS used as a triage tool, diagnostic ERCP and its related complications could be spared in 49 (75.4%) patients. Conclusions: In patients suspected to have biliary obstructive disease, EUS is a safe and accurate test to select patients for therapeutic ERCP. © 2008 American Society for Gastrointestinal Endoscopy.
 
dc.description.naturelink_to_subscribed_fulltext
 
dc.identifier.citationGastrointestinal Endoscopy, 2008, v. 67 n. 4, p. 660-668 [How to Cite?]
DOI: http://dx.doi.org/10.1016/j.gie.2007.07.025
 
dc.identifier.doihttp://dx.doi.org/10.1016/j.gie.2007.07.025
 
dc.identifier.epage668
 
dc.identifier.issn0016-5107
2013 Impact Factor: 4.900
 
dc.identifier.issue4
 
dc.identifier.pmid18155205
 
dc.identifier.scopuseid_2-s2.0-40949100455
 
dc.identifier.spage660
 
dc.identifier.urihttp://hdl.handle.net/10722/163151
 
dc.identifier.volume67
 
dc.languageeng
 
dc.publisherMosby, Inc. The Journal's web site is located at http://www.elsevier.com/locate/gie
 
dc.publisher.placeUnited States
 
dc.relation.ispartofGastrointestinal Endoscopy
 
dc.relation.referencesReferences in Scopus
 
dc.subject.meshAdult
 
dc.subject.meshAged
 
dc.subject.meshAged, 80 And Over
 
dc.subject.meshCholangiopancreatography, Endoscopic Retrograde - Methods
 
dc.subject.meshCholedocholithiasis - Complications - Diagnosis
 
dc.subject.meshCholestasis, Extrahepatic - Diagnosis - Etiology
 
dc.subject.meshCommon Bile Duct
 
dc.subject.meshDiagnosis, Differential
 
dc.subject.meshEndosonography - Methods
 
dc.subject.meshFemale
 
dc.subject.meshFollow-Up Studies
 
dc.subject.meshHumans
 
dc.subject.meshMale
 
dc.subject.meshMiddle Aged
 
dc.subject.meshReproducibility Of Results
 
dc.subject.meshRetrospective Studies
 
dc.titleComparison of EUS and ERCP in the investigation with suspected biliary obstruction caused by choledocholithiasis: a randomized study
 
dc.typeArticle
 
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<contributor.author>Chan, HLY</contributor.author>
<contributor.author>Wu, JCY</contributor.author>
<contributor.author>Yung, MY</contributor.author>
<contributor.author>Ng, EKW</contributor.author>
<contributor.author>Lau, JYW</contributor.author>
<contributor.author>Sung, JJY</contributor.author>
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<description.abstract>Background: EUS may be used to reduce the need of diagnostic ERCP. Objective: Our purpose was to investigate the benefits and safety of an EUS-guided versus an ERCP-guided approach in the management of suspected biliary obstructive diseases caused by choledocholithiasis, in whom a US study is not diagnostic. Design: A randomized study. Setting: A university medical unit. Patients: Patients with clinical, biochemical, or radiologic suspicion of biliary obstruction. Interventions: In the EUS group, therapeutic ERCP was performed at the same EUS session if a lesion was found. In the ERCP group, therapeutic treatment was carried out at the discretion of the endoscopist. Main Outcome Measurements: The number of ERCPs avoided, procedure-related complications, and recurrent biliary symptoms on follow-up at 1 year. Results: Thirty-three patients were randomized to EUS and 32 to ERCP. Three patients (9.4%) had failed ERCPs, whereas all EUS procedures were successful. Nine (27.3%) patients in the EUS group were found to have biliary lesions that were all treated by ERCP. In the ERCP group, 7 (22%) patients had biliary lesions detected that were treated in the same session. More patients had serious complications (bleeding, acute pancreatitis, and umbilical abscess) in the ERCP group. One patient in each group had recurrent biliary symptoms during follow-up. With EUS used as a triage tool, diagnostic ERCP and its related complications could be spared in 49 (75.4%) patients. Conclusions: In patients suspected to have biliary obstructive disease, EUS is a safe and accurate test to select patients for therapeutic ERCP. &#169; 2008 American Society for Gastrointestinal Endoscopy.</description.abstract>
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Author Affiliations
  1. Prince of Wales Hospital Hong Kong