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Endoscopic ultrasound elastography as a method for screening the patients with suspected primary sclerosing cholangitis

Rustemovic, Nadana; Cukovic-Cavka, Silvijaa; Opacic, Milorada; Petrovecki, Mladenb; Hrstic, Irenaa; Radic, Davora; Ostojic, Rajkoa; Pulanic, Rolanda; Vucelic, Borisa

European Journal of Gastroenterology & Hepatology: June 2010 - Volume 22 - Issue 6 - p 748-753
doi: 10.1097/MEG.0b013e32832d489f
Original Articles: Primary sclerosing cholangitis

Objectives Currently, magnetic resonance cholangiography is being used for establishing the diagnosis of primary sclerosing cholangitis, whereas endoscopic retrograde cholangiography is reserved for therapeutic interventions. The aim of this study was to determine the role of endoscopic ultrasound elastography in the detection of inflammatory and fibrotic lesions of the common bile duct.

Methods Linear endoscopic ultrasound elastography of the common bile duct was performed in 41 patients. The patients were divided into two groups: disease group (20 patients with both, primary sclerosing cholangitis and inflammatory bowel disease) and control group (21 patients). Main outcome measurements were diameter, wall thickness and wall qualitative Elasto Score of the common bile duct.

Results The disease group consisted of nine females and 11 males, whereas the control group consisted of 13 females and eight males, with no sex differences observed (χ2 = 0.6, d.f. = 1, P = 0.443). There was no significant difference in the diameter of common bile duct between the studied groups: 4.67±1.83 mm in the disease group and 5.88±2.47 mm in controls (t = −1.77, d.f.  = 39, P = 0.085). Hard or mixed Elasto Score was found in 16 patients and four controls, being significantly different compared with the soft Elasto Score found in four patients and 17 controls (χ2 = 1.8, d.f.  = 1, P<0.001). A significant difference was observed in the common bile duct wall thickness: 0.89±0.59 mm in the disease group and 0.39±0.14 mm in controls (t = 3.75, d.f.  = 39, P<0.001).

Conclusion Endoscopic ultrasound elastography might be a useful noninvasive method in diagnosing primary sclerosing cholangitis.

aDivision of Gastroenterology, University Hospital Zagreb – Rebro

bDepartment of Laboratory Diagnosis, University Hospital Dubrava, Zagreb, Croatia

Correspondence to Dr Irena Hrstic, MD, PhD, Division of Gastroenterology, University Hospital Zagreb – Rebro, Kispaticeva 12, Zagreb 10000, Croatia

Tel: +385 1 2388 314; fax: +385 1 2420 100; e-mail:

Received 2 January 2009 Accepted 17 April 2009

© 2010 Lippincott Williams & Wilkins, Inc.