Point-of-care ultrasound to diagnose gallstone disease
Topic Status Complete
Point-of-care ultrasound to diagnose gallstone disease
Outcome of the appraisal
The use of portable point-of-care ultrasound (POCUS) to diagnose gallstone disease shows promise, but the current evidence is insufficient to support routine adoption.
Studies to date have primarily considered the diagnostic accuracy of POCUS but uncertainties remain about the effectiveness of POCUS when used alongside other investigations as part of clinical decision-making.
Due to uncertainties around clinical effectiveness, in particular the waiting time before receiving a scan, reliable conclusions about the potential economic consequences of using POCUS cannot be drawn.
Further research is recommended to demonstrate the clinical and cost effectiveness of portable POCUS in emergency and acute care settings.
Why was this topic appraised?
Gallstones are usually asymptomatic, but in a small number of cases (2 to 4%) gallstones can become trapped within the biliary system and can cause abdominal pain, inflammation and infection. This can further lead to more serious conditions that involve inflammation of the gallbladder, biliary tree and pancreas, such as cholecystitis, cholangitis and pancreatitis.
Diagnosing gallstones as a possible cause for abdominal pain in an acute or emergency care setting usually requires referral to a radiology department for an ultrasound, performed by an accredited technician. Effective point-of-care ultrasound could reduce the need for a radiology referral and therefore shorten time to diagnosis and treatment of gallstone disease and associated conditions.
Plain language summary
Gallstones are small stones that form in the gallbladder from fatty or mineral deposits. Most people who have gallstones experience no symptoms, however for some people the stones can irritate the gallbladder or block part of the system and cause pain and infection. This can lead to more serious and potentially life-threatening conditions.
Diagnosing gallstones can be difficult. People presenting with suspected gallstone disease are usually referred for radiology-performed ultrasound. This is usually performed in a radiology department and results are interpreted by a radiologist.
Point-of-care ultrasound (POCUS) could reduce the need for a radiology referral and therefore shorten time to diagnosis and treatment of gallbladder disease. POCUS is any type of ultrasound that is performed at or near the initial point of patient care. For example, this can include the outpatient clinics, A&E, GP practices and other outpatient or community settings. The ultrasound can be performed by different healthcare professionals. These devices are portable and can be the size of a laptop or mobile phone.
Health Technology Wales looked for evidence on the effectiveness of using hand-held or portable ultrasound to aid diagnosis in people with suspected gallstones. The evidence seen on the use of POCUS to diagnose gallstone disease shows promise, but the current evidence is insufficient to support routine adoption.
Topic Exploration Report
TER175 06.2020
Evidence Appraisal Review
EAR029 03.2021
Guidance
GUI029 03.2021
Health Technology Wales Partners
