EUS bile duct project
Evaluation of different diagnostic procedures in patients admitted for ERCP due to suspected pancreaticobiliary disease (presentation of a ph.d. project)
ERCP has for 25 years been considered as ”gold standard” for the diagnosis and treatment of common bile duct stones and other causes of obstructive jaundice. In addition, the procedure is also used for diagnosing chronic pancreatitis and pancreatic cancer. However, ERCP is associated with a complication risk of 5 – 10 %, for which reason it is desirable to reduce the number of diagnostic ERCPs. Previous research have shown, that many patients with suspected pancreatobiliary disease can be exactly diagnosticated by either EUS (Fig 1.) or magnetic resonans cholangiopancreatography (MRCP), and the benefit of these investigations is a negligible risk of complications. However, the previous studies have been made on selected patients, and thus, no study so far have tried to evaluate EUS and MRCP as part of the diagnostic strategy in an unselected group of patients admitted for ERCP due to suspected pancreatobiliary disease.
Fig 1. : Normal common bil duct
The
Department of Surgery, Vejle Hospital, Denmark perform all ERCPs in Vejle County
(350.000 inhabitants). Patients admitted for planned ERCP can be included in the
project after informed consent. An inclusion of 200 patients over a two year
period (1 June 2000 to 31 May 2002) is expected. Each patient is examined with
EUS, MRCP og ERCP in the mentioned order by three different investigators. Each
investigator has no knowledge of the results of the other investigators. After
all three investigations in a patient are completed, the results are compared.
Certain criterias are made for what is considered to be the final diagnosis for
each patient, and, thus, the sensitivity and specificity of each procedure can
be calculated. Looking at the risks and costs of each procedure together with
the sensitivity and specificity, an algoritm to the most cost-effective strategy
for patients suspected of pancreaticobiliary disease is made. (Fig 2.)
The study is the scientific basis for a ph.d. study programme for Alan Patrick Ainsworth, MD, and is made in collaboration with the Department of Surgery, Odense University Hospital, Denmark.
Fig 2. Common bile duct stone