The role of endoscopic ultrasound in the evaluation of chronic mesenteric ischaemia

• Published in: Digestive and liver disease 2011-06, Vol.43 (6), p.470-474
• Main Authors: Almansa, Cristina, Bertani, Helga, Noh, Kyung W, Wallace, Michael B, Woodward, Timothy A, Raimondo, Massimo
• Format: Article
• Language: English
• Subjects: Abdominal Pain - diagnostic imaging; Abdominal Pain - etiology; Aged; Aged, 80 and over; Chronic abdominal pain; Chronic Disease; Chronic mesenteric ischaemia; Diagnosis, Differential; Doppler; Endoscopic ultrasound; Endosonography - methods; Female; Gastroenterology and Hepatology; Humans; Ischemia - complications; Ischemia - diagnostic imaging; Male; Mesenteric Arteries - diagnostic imaging; Mesenteric Arteries - pathology; Mesenteric Vascular Occlusion - complications; Mesenteric Vascular Occlusion - diagnostic imaging; Middle Aged; Pilot Projects; Prospective Studies; Sensitivity and Specificity; Ultrasonography, Doppler
• ISSN: 1590-8658; 1878-3562
• DOI: 10.1016/j.dld.2011.01.003

Abstract Introduction Doppler transabdominal ultrasound is a validated screening test for chronic mesenteric ischaemia, but gas and obesity are limitations. Endoscopic ultrasound has been proposed as a comprehensive test to evaluate chronic upper abdominal pain and is capable of Doppler measurement. We aim to evaluate the accuracy of Doppler endoscopic ultrasound (D-EUS) as a single screening test to rule out chronic mesenteric ischaemia in patients with abdominal pain and compare it with Doppler transabdominal ultrasound (D-TUS). Methods We enrolled all patients ≥50 years with chronic upper abdominal pain and vascular risk referred for endoscopic ultrasound. All were scheduled for D-EUS and D-TUS plus a confirmatory test if one of the previous resulted positive. We estimated the accuracy of both techniques comparing them using McNemar test. Results 68 patients completed the study. Fifty-three (78%) underwent D-EUS, D-TUS, and a confirmatory test. Fifteen (38%) underwent follow-up after negative results. Three (4%) in the D-EUS group and 14 in the D-TUS (21%) were excluded due to artefacts. D-EUS presented a sensitivity of 63%, specificity of 84%, whilst D-TUS presented a sensitivity of 80% and a specificity of 78%. Specificity of D-EUS was not significantly different to D-TUS. Conclusions These results support the role of Doppler endoscopic ultrasound to exclude chronic mesenteric ischaemia as cause of chronic abdominal pain.