NEW YORK (Reuters Health) – For diagnosing the cause of upper abdominal pain, upper endoscopy plus endoscopic ultrasound (EUS) is at least as good as upper endoscopy and transabdominal ultrasound (TUS), and in some cases better, according to a new study reported online July 22nd in Gastrointestinal Endoscopy.

Dr. Kenneth J. Chang at the University of California, Irvine Medical Center, and colleagues note that upper abdominal pain accounts for about 43% of upper endoscopies performed in the USA, and that TUS is often also used in such cases.

EUS has been shown to be a very diagnostic tool, Dr. Chang noted in comments to Reuters Health. “However, we usually consider EUS late in our clinical algorithm, often after several images tests have been non-diagnostic.”

The researchers postulated that “EUS combines the attributes of both upper endoscopy and TUS within a single instrument.” Thus, EUS early in the work-up might be as effective as upper endoscopy plus TUS for the diagnostic evaluation of upper abdominal pain.

The team tested this in a multicenter study involving 172 patients with upper abdominal pain, most (59%) for longer than a year. They first underwent upper endoscopy with tandem EUS, and then TUS within 4 weeks.

The cause of upper abdominal pain was ultimately identified in 66 of the patients. In order of frequency, the diagnoses were gallbladder disease, esophagitis/GERD, peptic ulcer disease, chronic pancreatitis, pancreatic malignancy, and “other”.

Among these 66 patients, the diagnostic rate was 64% with upper endoscopy plus EUS, compared with 61% using upper endoscopy plus TUS (p=0.27). EUS was better than TUS at detecting chronic pancreatitis and biliary stones.

Dr. Chang and colleagues conclude, “Upper endoscopy combined with EUS should be considered in the first-line diagnostic evaluation of patients with upper abdominal pain.”

In fact, Dr. Chang added, “The impact of this paper, in my opinion, is that it puts EUS at the front of the clinical algorithm for a very common problem, the patient with upper abdominal pain.”

Reference:

Endoscopic ultrasound effective for investigating abdominal pain

Gastrointest Endosc 2010