Use of endoscopic ultrasound and stimulated bilary drainage in the diagnosis of cholecystitis and microlithiasis

A method for diagnosing the cause of right upper quadrant abdominal pain in a patient having a gallbladder which is substantially intact comprises the following steps:

• (a) conducting a transabdominal ultrasound test, wherein if said transabdominal ultrasound test is positive then the patient would be a good candidate for a cholecystectomy and if normal then go to step (b);
• (b) conducting an oral cholecystography test to determined the concentrating ability of said gallbladder, wherein if said oral cholecystography test reveals a decreased concentrating ability then the patient would be a good candidate for a cholecystectomy and if normal then go to step (c);
• (c) conducting a combined endoscopic ultrasound and stimulated biliary drainage, utilizing an intravenously delivered cholecystokinin analogue, test if dietary and/or pharmaceutical therapy does not alleviate the right upper quadrant abdominal pain of said patient, wherein if said combined endoscopic ultrasound and stimulated biliary drainage test is positive then said patient would be a good candidate for a cholecystectomy and if normal then go to step (d);
• (d) conducting an endoscopic retrograde cholangiography test to determine whether any gallstones are present in the common bile duct, wherein if any gallstones are present then said patient would be a good candidate for a either an endoscopic sphincterotomy or a cholecystectomy and if no gallstones are present then go to step (e);
• and
• (e) conducting a sphincter of oddi manometry test to determine if there is elevated sphincter of oddi basal pressure, wherein if there is at least 40 mm of mercury sphincter of oddi pressure then said patient would be a good candidate for an endoscopic sphincterotomy and if less than 40 mm of mercury then the candidate would be a good candidate for dietary and/or pharmaceutical therapy.

A method for diagnosing subtle cholecystitis or microlithiasis of a gallbladder in a patient which comprises the following steps:

• inserting an endoscopic ultrasound device within the antrum of a stomach;
• positioning said endoscopic ultrasound device within said stomach such that said endoscopic ultrasound device is allowed to have a substantially unobstructed view of said gallbladder;
• activating said endoscopic ultrasound device such that it is capable of detecting whether said gallbladder exhibits any of the following:
• gallbladder sludge or small gallstones, focal wall thickening, or adhesions about said gallbladder and/or cystic duct;
• delivering magnesium sulfate intraluminally via said endoscopic ultrasound device to said patient in order to stimulate bile flow from said gallbladder by relaxing the biliary sphincter of oddi;
• and
• removing gallbladder bile from said patient and analyzing said gallbladder bile to detect the presence or absence of calcium bilirubinate and/or cholesterol granules or crystals therein.

A method for diagnosing the cause of right upper quadrant abdominal pain in a patient having a gallbladder which is substantially intact comprises the following steps:

• (a) conducting a transabdominal ultrasound test, wherein if said transabdominal ultrasound test is positive then the patient would be a good candidate for a cholecystectomy and if normal then go to step (b);
• (b) conducting an oral cholecystography test to determined the concentrating ability of said gallbladder, wherein if said oral cholecystography test reveals a decreased concentrating ability then the patient would be a good candidate for a cholecystectomy and if normal then go to step (c);
• (c) conducting a combined endoscopic ultrasound and stimulated biliary drainage, utilizing an intraluminally delivered magnesium sulfate, test if dietary and/or pharmaceutical therapy does not alleviate the right upper quadrant abdominal pain of said patient, wherein if said combined endoscopic ultrasound and stimulated biliary drainage test is positive then said patient would be a good candidate for a cholecystectomy and if normal then go to step (d);
• (d) conducting an endoscopic retrograde cholangiography test to determine whether any gallstones are present in the common bile duct, wherein if any gallstones are present then said patient would be a good candidate for a either an endoscopic sphincterotomy or a cholecystectomy and if no gallstones are present then go to step (e);
• and
• (e) conducting a sphincter of oddi manometry test to determine if there is elevated sphincter of oddi basal pressure, wherein if there is at least 40 mm of mercury sphincter of oddi pressure then said patient would be a good candidate for an endoscopic sphincterotomy and if less than 40 mm of mercury then the candidate would be a good candidate for dietary and/or pharmaceutical therapy.