Prospective Evaluation of Endosonography in the Diagnosis of Biliary Microlithiasis in Patients with Normal Transabdominal Ultrasonography

Introduction and

Prior investigators have proposed microlithiasis as a causative factor for occult gallbladder diseases. Endoscopic ultrasonography (EUS) is potentially far more sensitive than transabdominal ultrasonography (TUS) in visualizing small stones. The aim of this study was to investigate the role of endoscopic ultrasounography (EUS) in the diagnosis of microlithiasis in patients with upper abdominal pain and normal transabdominal ultrasonography (TUS).

Thirty-five patients with biliary-type abdominal pain and normal TUS were prospectively studied. All patients underwent radial EUS by means of an echoendoscope (Olympus, GF-UM20).

Of 35 patients, 33 revealed to have gallbladder sludge or small stones, and 21 had common bile duct (CBD) sludge or microlithiasis. Nine patients dropped during the follow-up, however, of the remaining, 13 underwent combined endoscopic biliary sphincterotomy and cholecystectomy, 10 subjected for cholecystectomy and 3 received biliary sphincterotomy alone. In a postoperative follow-up of 9.2 months, 25 patients (96.2%) became symptom-free.

EUS is an important diagnostic tool in patients with unexplained biliary colic. Cholecystectomy with or without ES are effective treatment modalities in these settings.