Journal of Hepatology and Gastrointestinal disorders
Open Access

Abstract

Clinical Impact of Endoscopic Ultrasonography in Pancreaticobiliary and Upper Gastrointestinal Diseases

Knut Johnsen, Rolv-Ole Lindsetmo and Jon Florholmen

Objective: Endoscopic ultrasonography (EUS) is one of the most significant advances for imaging the gastrointestinal tract wall and contiguous organs in the past 20 years. This method has been extensively evaluated, with special emphasis on specificity and sensitivity. However, there are few publications on the clinical impact of EUS. The objective of the study was to evaluate the sensitivity (Se), specificity (Sp), positive and negative predictive values (PPV and NPV) and the accuracy (AC) of endoscopic ultrasonography (EUS) in a clinical setting and study the clinical impact of EUS in pancreaticobiliary and upper gastrointestinal diseases.
Materials and Methods: EUS was performed in 197 patients with clinical signs indicating pancreaticobiliary or upper gastrointestinal diseases. Both radial and linear multifrequency scanners were available. Parallel examinations were performed by external ultrasonography, gastroduodenoscopy, endoscopic retrograde pancreatography, computed tomography and body magnetic resonance imaging. To evaluate the clinical impact of EUS, two clinicians (specialities in medical and surgical gastroenterology) analysed the data, with an observation time of at least 6 months after the clinical event.
Results: The overall accuracy, sensitivity and NPV of EUS were 100%, 95% and 100%. The overall clinical impact was 35%. After the EUS examination, the diagnoses were down-graded in 12% of cases and up-graded in 23%. The NPV was 100%.
Conclusions: EUS appears to have a high clinical impact and exhibits a high NPV. These observations justify using EUS as a first-line tool in the diagnosis of pancreaticobiliary and upper gastrointestinal diseases.