Ultrasonic evaluation of common bile duct stones: prospective comparison with endoscopic retrograde cholangiopancreatography.

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Abstract
Ultrasound is the modality of choice for the diagnosis of cholelithiasis and for the evaluation of the intra- and extrahepatic biliary tree in the patient with jaundice, but its role in the diagnosis of choledocholithiasis is less certain. Ninety patients who were to undergo endoscopic retrograde cholangiopancreatography (ERCP) by performing right upper quadrant sonography immediately prior to ERCP were prospectively examined. The size of the intra- and extrahepatic ducts and the presence or absence of calculi were assessed. ERCP, which was successfully performed in 77 of 94 attempted examinations, percutaneous transhepatic cholangiogrpahy or surgical follow-up composed the diagnostic standard for comparison. Ultrasound was not accurate in the diagnosis (sensitivity, 25%) or exclusion (value of a negative study, 73%) of choledocholithiasis. Furthermore, in the postcholecystectomy patient population, ultrasound assessment of biliary duct size is not a useful predictor of biliary disease. For symptomatic postcholecystectomy patients, ERCP is recommended as the initial diagnostic modality.

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