Diagnosis of choledocholithiasis

Abstract

Diagnostic procedures of choledocholithiasis including US, CT, MRCP, ERCP, EUS, and IDUS were reviewed. US is the most safe procedure, but detection rate of choledocholithiasis is reported with 25-75%. Diagnosis of DIC-CT for choledocholithiasis is appreciated with 65-100% of sensitivity, 84-100% of specificity. MRCP and EUS are superior to other diagnostic images. Diagnosis of MRCP for choledocholithiasis is sensitivity 85%, specificity 93%, positive predictive value 87%, and negative predictive value 92%, and whereas EUS sensitivity 93%, specificity 96%, positive predictive value 93%, and negative predictive value 96%, respectively. There is no statistical difference between EUS and MRCP. It is decreasing to perform ERCP alone because of complication such as post ERCP pancreatitis. Diagnosis of ERCP for choledocholithiasis is reported with 67-97% of sensitivity and 82-100% of specificity. Diagnosis of IDUS for choledocholithiasis was reported as 100% of accuracy and sensitivity of 100%, compared with ERCP as 86.7% of accuracy and sensitivity of 92.9%. IDUS is reported as a useful method for diagnosis of remaining stones after endoscopic treatment. Because acute cholangitis caused by choledocholithiasis may become life-threatening, we have to diagnose earlier by making full use of these diagnostic images.