Comprehensive Summary
Eren et al. evaluated the diagnostic performance of ultrasound (USG) and computed tomography (CT) for obstructive jaundice in the emergency department using endoscopy retrograde cholangiopancreatography (ERCP) as the reference standard. The retrospective diagnostic accuracy study compared the sensitivity and specificity of USG and CT for common obstructive patterns (choledocholithiasis, biliary strictures, malignant obstruction, and ductal dilation). The study was aimed at testing the reliability of different imaging methods by examining the diagnostic value of USG and CT in obstructive jaundice patients. Data were retrospectively collected from 1,011 consecutive patients who underwent ERCP at the Emergency Medicine Clinic of Ankara Bilkent City Hospital between January 2022 and December 2023. Data were obtained from 1,011 patients who underwent ERCP at the Emergency Medicine Clinic of Ankara Bilkent City Hospital. The study assessed the diagnostic accuracy of USG and CT for choledocholithiasis, biliary strictures, malignant obstruction, and ductal dilatation. For choledocholithiasis, USG demonstrated low sensitivity (20.8%) but high specificity (86.0%) (Eren et al.). CT was more sensitive for choledocholithiasis (sensitivity 57.6%) with comparable specificity (80.9%) (Eren et al.). Overall, CT outperformed USG in sensitivity across obstructive diagnoses, while USG tended to retain higher specificity. Given its accessibility and noninvasive nature, USG remains an appropriate first-line ED test; however, a negative or equivocal USG when clinical suspicion persists should prompt CT imaging.
Outcomes and Implications
Clinically, the study clarifies trade-offs between modalities in the ED: USG is rapid and specific, whereas CT provides greater sensitivity for obstructive pathology. USG remains valuable as a rapid, noninvasive initial screening tool in the ED, but its limited sensitivity means it cannot reliably exclude choledocholithiasis. CT is an appropriate next step when USG is negative or indeterminate but clinical suspicion remains high; clinicians should weigh CT’s higher sensitivity against radiation exposure, contrast use, and local availability. A pragmatic, stepwise ED pathway: initial USG followed by CT when results are negative/equivocal but suspicion remains, can improve diagnostic yield and speed appropriate management, though pathways should be adapted to local resources and patient risk.