Original articleClinical endoscopyEUS: a meta-analysis of test performance in suspected choledocholithiasis
Section snippets
Search strategy
The systematic review was performed according to developed guidelines for conducting diagnostic reviews.44 We searched MEDLINE (1966 to February 2006), EMBASE (1980 to February 2006), the Cochrane Database of Systematic Reviews, the Cochrane Controlled Trials Register, and the Database of Reviews of Effectiveness. Medical subject headings “endosonography” and “choledocholithiasis” were combined with free-text terms, screening title, abstract, and subject heading for endoscopic ultrasound,
Literature search
A total of 165 studies were initially identified by using the search strategy. Two independent reviewers excluded 128 studies after a preliminary review of titles and abstracts, which left 37 for detailed evaluation. Of these 37 potentially eligible studies, 25 published articles that met the inclusion and exclusion criteria were identified. Two additional unpublished studies in abstract form were identified by a manual search. In total, 27 studies were deemed appropriate for the meta-analysis.
Discussion
This systematic review of EUS for patients with suspected CBDS found that an EUS had excellent diagnostic accuracy, with an AUC of 0.98. Our findings suggest that EUS results can be taken as conclusive evidence for both ruling in (positive LR 22.41) and ruling out (negative LR 0.09) the diagnosis of CBDS. Because an EUS offers high resolution (0.1 mm), it is likely that the superiority of an EUS compared with an MRCP or an ERCP is primarily evident in the detection of small stones.
Acknowledgments
The authors wish to thank the two international content experts for this study: Pascal Burtin (France) and Laurent Palazzo (France).
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Presented at Digestive Disease Week, May 20-23, 2007, Washington DC (Gastrointest Endosc 2007;65:AB360).