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

Theodor Bilharz Research Institute

Bibliographic Information

Authors: Ghoname M.; Mohamed D.M.A.; Mahran A.A.S.; Abdelmalik A.; Ghazy A.M.; Aboismail A.A.M.; Youssef M.Z.; Ali R.F.; Shaaban A.A.A.; Helmy H.A.; Kandyl M.A.-H.; El-Seaidy M.A.A.E.A.; Hegab S.M.E.A.; Mohamed M.S.E.; Mashaal S.A.

Journal: Natural Resources for Human Health

Publisher: Visagaa Publishing House

Publication Date: 2026

Volume / Issue: Volume 6 / Issue 2S

Pages: 749–758

ISSN: 25831194

Scopus: View on Scopus

Document Type: Article

Authors and Affiliations

Ghoname M., Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt; Mohamed D.M.A., Department of Gastroenterology and Hepatology, Theodor Bilharz Research Institute, Giza, Egypt, Faculty of Medicine, Ain Shams University, Cairo, Egypt; Mahran A.A.S., Department of Internal Medicine, Faculty of Medicine, New Valley University, New Valley, Egypt; Abdelmalik A., Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt; Ghazy A.M., Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt; Aboismail A.A.M., Department of Tropical Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt; Youssef M.Z., Department of General Surgery, Faculty of Medicine, October 6thUniversity, Giza, Egypt; Ali R.F., Department of Radiodiagnosis and Interventional Radiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt; Shaaban A.A.A., Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt; Helmy H.A., Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebin El-Kom, Egypt; Kandyl M.A.-H., Department of Gastroenterology and Hepatology, Theodor Bilharz Research Institute, Giza, Egypt, Department of Medicine, Division of Gastroenterology, Jaber Al-Ahmad Armed Forces Hospital, Kuwait; El-Seaidy M.A.A.E.A., Department of Geriatric Medicine and Gerontology, Faculty of Medicine, Ain Shams University, Cairo, Egypt; Hegab S.M.E.A., Department of Hepatology, Gastroenterology and Infectious Diseases, Ahmed Maher Teaching Hospital, Cairo, Egypt; Mohamed M.S.E., Department of Hepatology, Gastroenterology and Infectious Diseases, Ahmed Maher Teaching Hospital, Cairo, Egypt; Mashaal S.A., Department of Tropical Medicine and Infectious Diseases, Faculty of Medicine, Tanta University, Tanta, Egypt

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. © 2026, Visagaa Publishing House. All rights reserved.

Keywords

Biliary Stricture; Diagnostic Reclassification; Endoscopic Ultrasound; Magnetic Resonance Cholangiopancreatography; Multidisciplinary Team; Post-cholecystectomy Complications; adult; Article; biliary tract disease; cholecystectomy; controlled study; decision making; diagnostic accuracy; diagnostic test accuracy study; digestive system; endoscopic retrograde cholangiopancreatography; endoscopic ultrasonography; endoscopist; female; gastroenterology; Hepatopancreatobiliary; human; major clinical study; male; middle aged; observational study; pathology; PostCholecystectomy Biliary Complication; predictive value; retrospective study

Citation Information

Scopus Citations: 0

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