Original article 1171 Acute biliary pancreatitis: detection of common bile duct stones with endoscopic ultrasound Borut S ˘ tabuc, David Drobne, Ivan Ferkolj, Andrej Gruden, Janez Jereb, Gorazd Kolar, Vladimir Mlinaric ˇ , Manfred Mervic, Aljaz ˇ Reps ˘e, Srec ˇko S ˘ tepec and Sas ˘ a Markovic ˇ Objectives To determine prospectively the sensitivity and specificity of endoscopic ultrasound (EUS) for detecting common bile duct stones (CBS) in patients with acute biliary pancreatitis in whom transabdominal ultrasound was negative for CBS. Methods In 38 consecutive patients with acute biliary pancreatitis who were negative for CBS by transabdominal ultrasound, EUS was performed before endoscopic retrograde cholangiopancreatography (ERCP). The endoscopist performing ERCP was blind to the results of EUS. The primary goal of EUS and ERCP was to confirm or exclude CBS. The reference standard for CBS was endoscopic extraction of bile duct stones after endoscopic sphincterotomy. When both procedures, EUS and ERCP excluded CBS, it was assumed that there were no CBS and endoscopic sphincterotomy was not performed. The results EUS and ERCP were compared with the McNemar test. Results Twenty-five of the 38 patients (66%) had CBS. EUS and ERCP were false negative in one patient each, EUS was false positive in two patients and ERCP in one patient. The sensitivity of both EUS and ERCP was 96%. The specificity of EUS and ERCP was 85 and 92%, respectively. The difference between EUS and ERCP was not significant (P = 0.9). Conclusion EUS proved to be as sensitive as ERCP for detection of CBS in patients with acute biliary pancreatitis. Therefore, EUS could be used as the first-line procedure in patients with acute biliary pancreatitis when therapeutic ERCP is not needed. By this approach a substantial number of unnecessary diagnostic ERCP procedures could be avoided. Eur J Gastroenterol Hepatol 20:1171–1175  c 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins. European Journal of Gastroenterology & Hepatology 2008, 20:1171–1175 Keywords: acute biliary pancreatitis, choledocholithiasis, common bile duct stones, endoscopic ultrasound, endoscopic retrograde cholangiopancreatography Department of Gastroenterology, University Medical Centre Ljubljana, Slovenia Correspondence to David Drobne, Department of Gastroenterology, University Medical Centre Ljubljana, Japljeva 2, Ljubljana 1000, Slovenia Tel: + 38 641 334 324; e-mail: david.drobne@siol.net Received 2 February 2008 Accepted 29 May 2008 Introduction Acute biliary pancreatitis is a serious complication of common bile duct stones. The disease carries significant morbidity and mortality. This can be reduced by early removal of the retained stones from the ductus chole- dochus using endoscopic retrograde cholangiopancrea- tography (ERCP) and endoscopic sphincterotomy (ES) [1–3]. Patients with acute biliary pancreatitis can be divided into two groups according to the therapy needed. The first group consists of patients in whom biliary stones have passed spontaneously from the common bile duct through the papilla of Vater; these patients need only conservative measures. The second group includes patients who have retained common bile duct stones. It is now well established that only this second group of patients benefit from ERCP with ES and stone removal whereas patients from the first group do not [1,2]. Since the introduction of less invasive and safer imaging techniques, tools such as magnetic resonance cholangio- pancreaticography and endoscopic ultrasound (EUS), diagnostic ERCP with possibility of severe complications is being avoided more and more. Magnetic resonance cholangiopancreaticography has a high diagnostic sensi- tivity for common bile duct stones but its use is still limited because of low accessibility in many gastro- intestinal units [4]. EUS has proved to be highly accurate for detecting common bile duct stones [5–8]. Few studies have, however, tried to establish its role in the subgroup of patients with acute biliary pancreatitis [9–12], where accompanying pathological changes such as gas distension of the bowel, oedema and necrosis of the pancreas and surrounding tissues may limit its diagnostic yield. The aim of this study was to prospectively determine the sensitivity and specificity of EUS for detecting common 0954-691X  c 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins DOI: 10.1097/MEG.0b013e32830a9a31 Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.