Endosonography For Right-sided and Acute Upper Intestinal Misery: the EFRAIM study: A prospective, randomized, controlled, blinded study.

Abstract:

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

Jung A,Schlag C,Becker V,von Delius S,Lersch C,Jeliazkova P,Herner A,Bajbouj M,Schuster T,Meining A

doi

10.1177/2050640613498589

subject

Has Abstract

pub_date

2013-10-01 00:00:00

pages

329-34

issue

5

eissn

2050-6406

issn

2050-6414

pii

10.1177_2050640613498589

journal_volume

1

pub_type

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