EUS and Common bile duct stones

Choledocholithiasis is a common disorder, especially in patients older than 60 years, as common bile duct stones may be present in 15% to 60% of cases in this special sample of population. Until recently, endoscopic retrograde cholangiography (ERC), which is a very reliable method for visualizing and extracting gallstones in the same session, was considered the gold-standard for suspected choledocholithiasis; however the not negligible complication rate of diagnostic and therapeutic ERC has led to the evolution of EUS. EUS has proved to be of great sensitivity (up to 97%) for detecting even tiny stones that can easily be masked by contrast medium during ERCP, without any complications related to the procedure, and with a NPV reaching 100%, meaning that it can accurately and safely identify patients with choledocholithiasis and thereby avoid inappropriate instrumental exploration of the duct.