EUS versus MRCP to perform ERCP in patients with intermediate likelihood of choledocholithiasis: a randomised controlled trial

Nitin Jagtap; J Kiran Kumar; Radhika Chavan; Jahangeer Basha; Manu Tandan; Sundeep Lakhtakia; Rakesh Kalapala; Zaheer Nabi; Rajesh Gupta; Mohan Ramchandani; Rupjyoti Talukdar; Manohar Reddy; Raghavendra Yarlagadda; Jagadish Singh; Sana Fatima Memon; G Venkat Rao; D Nageshwar Reddy

doi:10.1136/gutjnl-2021-325080

EUS versus MRCP to perform ERCP in patients with intermediate likelihood of choledocholithiasis: a randomised controlled trial

Gut. 2022 Feb 10:gutjnl-2021-325080. doi: 10.1136/gutjnl-2021-325080. Online ahead of print.

Authors

Nitin Jagtap¹, J Kiran Kumar², Radhika Chavan², Jahangeer Basha², Manu Tandan², Sundeep Lakhtakia², Rakesh Kalapala², Zaheer Nabi², Rajesh Gupta², Mohan Ramchandani², Rupjyoti Talukdar², Manohar Reddy², Raghavendra Yarlagadda², Jagadish Singh³, Sana Fatima Memon², G Venkat Rao⁴, D Nageshwar Reddy²

Affiliations

¹ Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India docnits13@gmail.com.
² Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.
³ Department of Radiodiagnosis and Interventional Radiology, Asian Institute of Gastroenterology, Hyderabad, India.
⁴ Department of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.

PMID: 35144973
DOI: 10.1136/gutjnl-2021-325080

Abstract

Objective: In patients with an intermediate likelihood of choledocholithiasis, European Society of Gastrointestinal Endoscopy (ESGE) guidelines recommend endoscopic ultrasound (EUS) or magnetic resonance cholangiopancreatography (MRCP) to diagnose choledocholithiasis to make the indication for endoscopic retrograde cholangiopancreatography (ERCP) treatment; there is no randomised control trial to compare both in this setting.

Design: Patients with suspected choledocholithiasis satisfying ESGE guideline's intermediate likelihood were screened for this single-centre randomised controlled trial between November 2019 and May 2020. The enrolled patients were randomised to either EUS or MRCP. ERCP was performed in stone positive cases or if clinical suspicion persisted during follow-up. Negative cases underwent a further 6-month clinical follow-up. Main outcome was accuracy (sensitivity/specificity) of both tests to diagnose choledocholithiasis, with ERCP or follow-up as a gold standard.

Results: Of 266 patients, 224 patients (mean age: 46.77±14.57 years; 50.9 % female) were enrolled; overall prevalence of choledocholithiasis was 49.6%, with a higher frequency in the MRCP group (63/112 vs 46/112 for EUS). Both sensitivity of EUS and MRCP were similarly high (92%-98%), without significant differences between the two groups. The negative predictive value and likelihood ratio + were significantly higher in EUS arm (p<0.05). The percentage of ERCPs either incorrectly halted back (false negatives: EUS: 2 vs MRCP: 5) or performed unnecessarily (false positives: EUS: 1 vs MRCP: 2) was low in both groups.

Conclusion: The performance parameters of both EUS and MRCP are comparable for detecting choledocholithiasis in the intermediate-risk group of choledocholithiasis and the choice of a test should be based on local expertise, availability of resources and patient preference.

Trial registration number: NCT04173624.

Keywords: Magnetic Resonance Imaging; diagnostic and therapeutic endoscopy; endoscopic ultrasonography; gallstone disease; gallstones.

Associated data

ClinicalTrials.gov/NCT04173624