FROM GASTROINTESTINAL ENDOSCOPY
Endoscopic ultrasound (EUS) beat magnetic resonance cholangiopancreatography (MRCP) on diagnostic accuracy for choledocholithiasis, but both provided similar specificity, according to data from a meta-analysis of head-to-head comparisons. The findings were published in Gastrointestinal Endoscopy.
EUS and MRCP can provide accurate diagnosis of choledocholithiasis with lower adverse event rates than the clinical standards of endoscopic retrograde cholangiopancreatography and intraoperative cholangiography, but a meta-analysis of the diagnostic test accuracy (DTA) of the two methods was lacking, wrote Mohammad Yaghoobi, MD, of McMaster University, Hamilton, Ont., and his colleagues (Gastrointest Endosc. 2017. doi: 10.1016/j.gie.2017.06.009 ).
“The methodology of a meta-analysis of DTA is different from a conventional meta-analysis in several aspects, including statistical analysis and quality assessment of the included trials,” the researchers wrote.
They reviewed data from studies conducted between 1980 and January 2017 and identified five studies of head-to-head comparisons of EUS and MRCP. Studies involving children, and those with insufficient data, no reference standards, and a gap of more than 48 hours between two index tests were excluded.
Overall, the diagnostic odds ratio was significantly higher for EUS than MRCP (P = .008). This difference was mainly a factor of the significantly higher sensitivity of EUS vs. MRCP (P = .006). Specificity was not significantly different between the two tests.
The results were limited by several factors, including inadequate data for a subgroup analysis based on stone size and the relatively small number of studies included in the analysis, but the strict inclusion criteria add to the strength of the findings, the researchers noted.
“EUS should be incorporated in the diagnostic algorithm in patients suspected for choledocholithiasis, whenever appropriate, given its reasonable safety profile,” the researchers said. “This might specially apply to the patients who need an esophagogastroduodenoscopy for investigating other alternative causes of abdominal pain,” they added. The researchers had no financial conflicts to disclose.
