Background:

Endoscopic ultrasound (EUS) is an imaging modality with high accuracy in the diagnosis of biliary diseases. Its usefulness in the diagnosis of choledocholithiasis is well stablished, whereas its role in the clinical scenario of suspected pathology with biliary origin and negative imaging no invasive is unknown. The aim of the study was to evaluate the utility of the EUS in this clinical scenario performing a correlation between the EUS findings and the histopathology of the surgical piece post cholecystectomy.

Methods:

A prospective study was performed on patients with suspected biliary disease and transabdominal ultrasonography or abdominal tomography with no conclusive results. All patients were subsequently examined with EUS before the cholecystectomy was performed. We analyzed the ultrasonographic findings that correlate with the diagnosis of acute and acute on chronic cholecystitis.

Results:

A total of 34 patients (55.8% female) were included in a period of 18 months. In the histopathological findings, 11 (32.2%) were reported as acute cholecystitis and 23 (67.7%) as acute on chronic cholecystitis. The EUS was abnormal in all patients, 33 (97%) patients had cholelithiasis and 6 (18%) choledocholithiasis. With respect of the EUS findings with a positive correlation with the report of cholecystitis in the histopathology, the presence of adenopathy was the only one associated with acute cholecystitis (OR: 1.9; 95% CI: 1.2-3.2; p = 0.008), with a sensibility of 61%, specificity 91% and area under the curve of 0.73.

Conclusion:

The EUS seems to be a promising method in the context of patient with suspected biliary origin disease and inconclusive study with non-invasive imaging.