BACKGROUND: Acute upper abdominal pain is a frequent symptom leading to hospital admission. OBJECTIVE: To determine whether a primary intra- and extraluminal diagnostic approach enabled by endoscopic ultrasound is as effective as a conventional diagnostic algorithm of transabdominal ultrasound followed by oesophagogastroduodenoscopy. METHODS: A total of 240 patients who presented with acute right-sided and/or upper abdominal pain were prospectively recruited. Exclusion criteria were chronic pain, malignancy, prior abdominal surgery, bleeding, peritonitis, and elevated liver enzymes or lipase as defined 3-times higher than upper reference value. All patients underwent first transabdominal ultrasound and were then randomized (1 : 1) to either endoscopy followed by endoscopic ultrasound or vice versa. Patients and respective examiners were blinded to prior findings. RESULTS:A total of 223 patients were included. Endoscopic ultrasound provided a higher diagnostic yield than the combination of transabdominal ultrasound and endoscopy (62.3 vs. 50.7%; p = 0.001). For mucosal/intraluminal lesions, we observed a very good agreement between both endoscopic modalities (kappa 0.89). The agreement for pancreatic and biliary causes was good between both ultrasound modalities (kappa 0.66). CONCLUSIONS: Due to its high diagnostic yield, endoscopic ultrasound as a primary diagnostic modality appears to be a valuable option in patients with acute upper abdominal pain.
RCT Entities:
BACKGROUND:Acute upper abdominal pain is a frequent symptom leading to hospital admission. OBJECTIVE: To determine whether a primary intra- and extraluminal diagnostic approach enabled by endoscopic ultrasound is as effective as a conventional diagnostic algorithm of transabdominal ultrasound followed by oesophagogastroduodenoscopy. METHODS: A total of 240 patients who presented with acute right-sided and/or upper abdominal pain were prospectively recruited. Exclusion criteria were chronic pain, malignancy, prior abdominal surgery, bleeding, peritonitis, and elevated liver enzymes or lipase as defined 3-times higher than upper reference value. All patients underwent first transabdominal ultrasound and were then randomized (1 : 1) to either endoscopy followed by endoscopic ultrasound or vice versa. Patients and respective examiners were blinded to prior findings. RESULTS: A total of 223 patients were included. Endoscopic ultrasound provided a higher diagnostic yield than the combination of transabdominal ultrasound and endoscopy (62.3 vs. 50.7%; p = 0.001). For mucosal/intraluminal lesions, we observed a very good agreement between both endoscopic modalities (kappa 0.89). The agreement for pancreatic and biliary causes was good between both ultrasound modalities (kappa 0.66). CONCLUSIONS: Due to its high diagnostic yield, endoscopic ultrasound as a primary diagnostic modality appears to be a valuable option in patients with acute upper abdominal pain.
Authors: Martin Mockel; Julia Searle; Reinhold Muller; Anna Slagman; Harald Storchmann; Philipp Oestereich; Werner Wyrwich; Angela Ale-Abaei; Joern O Vollert; Matthias Koch; Rajan Somasundaram Journal: Eur J Emerg Med Date: 2013-04 Impact factor: 2.799
Authors: Kenneth J Chang; Richard A Erickson; Amitabh Chak; Charles Lightdale; Yang K Chen; Kenneth F Binmoeller; Gregory C Albers; Wen-Pin Chen; Christine E McLaren; Michael V Sivak; John G Lee; Gerard A Isenberg; Richard C K Wong Journal: Gastrointest Endosc Date: 2010-07-22 Impact factor: 9.427
Authors: A V Sahai; I D Penman; G Mishra; D Williams; A Pearson; M B Wallace; A van Velse; B J Hoffman; R H Hawes Journal: Endoscopy Date: 2001-08 Impact factor: 10.093
Authors: Yuk Tong Lee; Alex C W Lai; Yui Hui; Justin C Y Wu; Vincent K S Leung; Francis K l Chan; S C Sydney Chung; Joseph J Y Sung Journal: Gastrointest Endosc Date: 2002-12 Impact factor: 9.427
Authors: Christoph F Dietrich; Paolo Giorgio Arcidiacono; Barbara Braden; Sean Burmeister; Silvia Carrara; Xinwu Cui; Milena Di Leo; Yi Dong; Pietro Fusaroli; Uwe Gottschalk; Andrew J Healey; Michael Hocke; Stephan Hollerbach; Julio Iglesias Garcia; André Ignee; Christian Jürgensen; Michel Kahaleh; Masayuki Kitano; Rastislav Kunda; Alberto Larghi; Kathleen Möller; Bertrand Napoleon; Kofi W Oppong; Maria Chiara Petrone; Adrian Saftoiu; Rajesh Puri; Anand V Sahai; Erwin Santo; Malay Sharma; Assaad Soweid; Siyu Sun; Anthony Yuen Bun Teoh; Peter Vilmann; Hans Seifert; Christian Jenssen Journal: Endosc Ultrasound Date: 2019 Nov-Dec Impact factor: 5.628