Closing the Diagnostic-Therapeutic Gap in Post-Cholecystectomy Biliary Complications: Impact of Endoscopic Ultrasound on Diagnostic Reclassification and Therapeutic Decision-Making in a Multidisciplinary Hepatopancreatobiliary Pathway

Abstract

Background & Aim: Post-cholecystectomy biliary complications present diagnostic challenges due to frequent discordance between non-invasive and invasive imaging. This study evaluates the impact of Endoscopic Ultrasound (EUS) on diagnostic reclassification and therapeutic decision-making within a structured multidisciplinary hepatopancreatobiliary (HPB) pathway.
Methods: A retrospective observational cohort study of 50 patients with suspected post-cholecystectomy biliary complications was conducted. Patients underwent Ultrasonography (US), Magnetic Resonance Cholangiopancreatography (MRCP), EUS, and Endoscopic Retrograde Cholangiopancreatography (ERCP) when indicated. Diagnostic reclassification was categorized into Confirmation, Upgrading, Downgrading, and Additional Pathology.
Results: EUS resulted in a diagnostic reclassification rate of 50% (25/50). MRCP findings were downgraded by EUS in 22% of cases, upgraded in 22%, and revealed additional pathology in 6%. Imaging concordance (Cohen's Kappa) was moderate between MRCP and EUS (κ = 0.58) but almost perfect between EUS and ERCP (κ = 0.88). EUS altered the therapeutic plan in 50% of patients, significantly reducing unnecessary ERCPs.
Conclusion: EUS significantly improves diagnostic accuracy, reclassifies indeterminate biliary pathology, and optimizes therapeutic decision-making. Its integration into a multidisciplinary HPB pathway is essential for closing the diagnostic-therapeutic gap.