EUS, MRCP Comparable for Detecting Choledocholithiasis in Patients at Intermediate Risk

Researchers sought to compare EUS and MRCP to determine sensitivity and specificity in diagnosing choledocholithiasis in an intermediate likelihood group.

Endoscopic ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP) had comparable sensitivity and specificity for detecting choledocholithiasis in patients categorized as having intermediate likelihood of the condition, according to study results published in Gut.

For the analysis, researchers conducted a single-center, randomized controlled trial ( Identifier: NCT04173624), which included 224 patients who were classified as having an intermediate likelihood of choledocholithiasis, according to European Society of Gastrointestinal Endoscopy (ESGE) guidelines. Researchers screened study participants from November 2019 to May 2020. As recommended by the ESGE guidelines, patients were randomly assigned to EUS or MRCP for confirmation of choledocholithiasis requiring endoscopic retrograde cholangiopancreatography (ERCP).

Comparing the sensitivity of EUS and MRCP for detecting choledocholithiasis in the enrolled patient population was the primary study endpoint. The secondary endpoints included a comparison of the specificity of EUS and MRCP and adverse events.

The study data indicated no statistically significant difference in sensitivity vs specificity of EUS and MRCP for detecting choledocholithiasis (P =.29 and P =.22, respectively). Negative predictive value and positive likelihood ratio were statistically higher in EUS compared with MRCP.

Study limitations included using a single-center study design, lacking external validity, having expert endoscopists perform EUS and expert radiologists perform MRCP.

Overall, researchers concluded that “the sensitivity and specificity of both EUS and MRCP are comparable for detecting choledocholithiasis in the intermediate risk group of choledocholithiasis, and the choice of a test should be based on local expertise, availability of resources, and patient preference.”


Jagtap N, Kumar JK, Chavan R, et al. EUS versus MRCP to perform ERCP in patients with intermediate likelihood of choledocholithiasis: a randomized controlled trial. Gut. February 10, 2022. doi:10.1136/gutjnl-2021-325080