1
|
Prevalence of Endoscopic Retrograde Cholangiopancreatography Complications and Amylase Sensitivity for Predicting Pancreatitis in ERCP Patients. Gastroenterol Nurs 2020; 43:350-354. [PMID: 32889967 DOI: 10.1097/sga.0000000000000473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is a complex procedure that is widely used for diagnosis and treatment of biliary and pancreatic diseases. With respect to its growing application, the present study aims to evaluate ERCP outcomes and complications. This cross-sectional study was performed using the data from 824 patients who underwent ERCP during 2014-2017 in Qom Shahid Beheshti hospital. Data were collected by a checklist and analyzed using SPSS V22. Among 824 patients, 397 (48.18%) were male and 427 (51.82%) were female with a mean age of 47 ± 6 years. The most common indications for ERCP were choledocholithiasis (78.28%) and cholestasis (20.27%), respectively. Total prevalence of complications was 15.66% and mortality rate was 0.72%. The most common complications were pancreatitis (9.59%) and bleeding (3.28%), respectively. A serum amylase level of greater than 160 could predict pancreatitis with sensitivity of 93.3% and specificity of 90.3%. Endoscopic retrograde cholangiopancreatography-related complications are inevitable but can be controlled by early diagnosis and clinical experience. Severe complications and high-risk patients may increase the mortality of the procedure.
Collapse
|
2
|
The accuracy of 3T magnetic resonance cholangiopancreatography in suspected choledocholithiasis. Pol J Radiol 2019; 84:e419-e423. [PMID: 31969960 PMCID: PMC6964331 DOI: 10.5114/pjr.2019.89689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 09/23/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose The purpose of this study was to investigate interobserver agreement during magnetic resonance cholangio-pancreatography (MRCP) evaluation and the sensitivity and specificity of MRCP obtained with 3T scanners in cases of bile duct obstruction. Material and methods A total of 37 patients who had MRCP and endoscopic retrograde cholangiography (ERCP) were included. Choledochal pathology was divided into two groups regarding the presence of stones as "there is stone or not". MRCPs were performed with a 3-Tesla system using respiratory triggered HASTE technique in axial and coronal planes and with T2 SPACE sequence in the coronal plane. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated separately for each observer. The average of both observers was calculated for comparison with other studies. Results Thirty-seven patients were in the study population. Agreement between the observers was analysed, and Cohen's κ value was evaluated as 0.84. For two observers, the sensitivity of MRCP was 93%, whereas the specificity was 75% for the first observer and 62% for the second. Conclusions In this study we found a high level of interobserver agreement in evaluating MRCP. MRCP has a high sensitivity in detecting choledocholithiasis.
Collapse
|
3
|
Shen YZ, Peng XH, Bai Y, Xiong B, Che P, Jiang DQ. Clinical Observation of the Efficacy of Endoscopic Retrograde Cholangiopancreatography on Elder Choledocholithiasis and Its Effects on the Levels of TNF-α, IL-1, and IL-6. Rev Assoc Med Bras (1992) 2018; 64:1012-1016. [PMID: 30570053 DOI: 10.1590/1806-9282.64.11.1012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 02/25/2018] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE We conducted this study to investigate the clinical efficacy of endoscopic retrograde cholangiopancreatography (ERCP) on elder choledocholithiasis and its effects on the levels of TNF-α, IL-1, and IL-6. METHODS Elder patients with choledocholithiasis were enrolled in this study, and according to the surgical methods, they were divided into the ERCP group and the surgical group. After treatment, we compared the efficacy of these two methods on patients, inflammatory responses indicated by the levels of TNF-α, IL-1, and IL-6, and the complications. RESULTS No statistical significance was identified in the difference of the success rate in removal between the two groups (98% vs. 94%), but indicators of the ERCP group, including the surgical duration (28.5±12.8) min, remission duration of abdominal pain (1.2±0.2) d, recession time of jaundice (2.0±0.3) d, postoperative bedridden time (1.4±0.2) d, treatment time of the anti-infection (1.5±0.2) d, length of stay in hospital (6.5±0.3) d, levels of TNF-α (2.1±0.2) μg/L, IL-1 (6.3±0.8) μg/L, IL-6 (2.8±0.3) μg/L, and the incidence rate of complications (1.8%), were all significantly lower than those in the surgical group (p<0.05). CONCLUSION In the treatment of choledocholithiasis, ERCP is excellent in controlling the trauma, accelerating the recovery duration, reducing the occurrence of complications and ameliorating the inflammatory responses. Thus, it is an ideal choice for choledocholithiasis.
Collapse
Affiliation(s)
- Yun-Zhi Shen
- Tianjin third central hospital, Jiangjin district, Chongqing, China
| | - Xiao-Hui Peng
- Department of general surgery, Fifth Hospital of Xiamen, Jiangjin district, Chongqing, China
| | - Yu Bai
- Tianjin third central hospital, Jiangjin district, Chongqing, China
| | - Bin Xiong
- Department of hepatobiliary surgery, the Second Hospital Affiliated to Chongqing Medical University, Jiangjin district, Chongqing, China
| | - Ping Che
- Department of hepatobiliary surgery, the people's Hospital of Chongqing Hechuan, Jiangjin district, Chongqing, China
| | - De-Quan Jiang
- Department of the second lesion of general surgery, Jiangjin central hospital of Chongqing, Jiangjin district, Chongqing, China
| |
Collapse
|
4
|
Sun Z, Zhu Y, Zhu B, Xu G, Zhang N. Controversy and progress for treatment of acute cholangitis after Tokyo Guidelines (TG13). Biosci Trends 2016; 10:22-6. [PMID: 26961212 DOI: 10.5582/bst.2016.01033] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Tokyo Guideline 2013 (TG13) is an international guideline for the diagnosis, classification and treatment of acute cholangitis. Progress and controversy for the two years after TG13 was summarized. Endoscopic ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP) are both effective imaging tests for common bile duct (CBD) stones. More factors e.g. obesity may be involved in severity assessment. Initiation of broad-spectrum antibiotics addressing the typical Gram-negative enteric bacteria spectrum and early biliary drainage are the mainstay therapeutic options. Early laparoscopic exploration is also an option for stone-related nonsevere acute cholangitis besides endoscopic retrograde cholangial or percutaneous transhepatic cholangial drainage. Surgical biliary drainage should be avoided in severe cholangitis.
Collapse
Affiliation(s)
- Zhipeng Sun
- General Surgery Department, Peking University Ninth School of Clinical Medicine (Beijing Shijitan Hospital, Capital Medical University)
| | | | | | | | | |
Collapse
|
5
|
Hjartarson JH, Hannesson P, Sverrisson I, Blöndal S, Ívarsson B, Björnsson ES. The value of magnetic resonance cholangiopancreatography for the exclusion of choledocholithiasis. Scand J Gastroenterol 2016; 51:1249-56. [PMID: 27181286 DOI: 10.1080/00365521.2016.1182584] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To investigate the ability of Magnetic resonance cholangiopancreatography (MRCP) to exclude choledocholithiasis (CDL) in symptomatic patients. MATERIAL AND METHODS Patients suspected of choledocholithiasis who underwent MRCP from 2008 through 2013 in a population based study at the National University Hospital of Iceland were retrospectively analysed, using ERCP and/or intraoperative cholangiography as a gold standard diagnosis for CDL. RESULTS Overall 920 patients [66% women, mean age 55 years (SD 21)] underwent MRCP. A total of 392 patients had a normal MRCP of which 71 underwent an ERCP investigation demonstrating a CBD stone in 29 patients. A normal MRCP was found to have a 93% negative predictive value (NPV) and 89% probability of having no CBD stone demonstrated as well as no readmission due to gallstone disease within six months following MRCP. During a 6-month follow-up period of the 321 patients who did not undergo an ERCP nine (2.8%) patients were readmitted with right upper quadrant pain and elevated liver tests which later normalised with no CBD stone being demonstrated, three (0.9%) patients were readmitted with presumed gallstone pancreatitis, two (0.6%) patients were readmitted with cholecystitis and two (0.6%) patients were lost to follow-up. Seven patients of those 321 underwent an intraoperative cholangiography (IOC) and all were negative for CBD stones. For the sub-group requiring ERCP following a normal MRCP the NPV was 63%. CONCLUSION Our results support the use of MRCP as a tool for exclusion of choledocholithiasis with the potential to reduce the amount of unnecessary ERCP procedures.
Collapse
Affiliation(s)
- Jón H Hjartarson
- a Department of Gastroenterology and Hepatology , The National University Hospital of Iceland , Reykjavík , Iceland
| | - Pétur Hannesson
- b Department of Radiology , The National University Hospital of Iceland , Reykjavík , Iceland
| | - Ingvar Sverrisson
- c Department of Surgery , The National University Hospital of Iceland , Reykjavík , Iceland
| | - Sigurður Blöndal
- c Department of Surgery , The National University Hospital of Iceland , Reykjavík , Iceland
| | - Bjarki Ívarsson
- b Department of Radiology , The National University Hospital of Iceland , Reykjavík , Iceland
| | - Einar S Björnsson
- a Department of Gastroenterology and Hepatology , The National University Hospital of Iceland , Reykjavík , Iceland
| |
Collapse
|
6
|
Imaging Techniques in Emergency Surgeries. Int Anesthesiol Clin 2016; 54:22-38. [PMID: 26655507 DOI: 10.1097/aia.0000000000000086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
7
|
EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol 2016; 65:146-181. [PMID: 27085810 DOI: 10.1016/j.jhep.2016.03.005] [Citation(s) in RCA: 267] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 03/09/2016] [Indexed: 02/06/2023]
|
8
|
Factors and Outcomes Associated with MRCP Use prior to ERCP in Patients at High Risk for Choledocholithiasis. Can J Gastroenterol Hepatol 2016; 2016:5132052. [PMID: 27446845 PMCID: PMC4904705 DOI: 10.1155/2016/5132052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 11/01/2015] [Indexed: 02/07/2023] Open
Abstract
Background. Consensus guidelines recommend that patients at high risk for choledocholithiasis undergo endoscopic retrograde cholangiopancreatography (ERCP) without additional imaging. This study evaluates factors and outcomes associated with performing magnetic resonance cholangiopancreatography (MRCP) prior to ERCP among patients at high risk for choledocholithiasis. Methods. An institutional administrative database was searched using diagnosis codes for choledocholithiasis, cholangitis, and acute pancreatitis and procedure codes for MRCP and ERCP. Patients categorized as high risk for choledocholithiasis were evaluated. Results. 224 patients classified as high risk, of whom 176 (79%) underwent ERCP only, while 48 (21%) underwent MRCP prior to ERCP. Patients undergoing MRCP experienced longer time to ERCP (72 hours versus 35 hours, p < 0.0001), longer length of stay (8 days versus 6 days, p = 0.02), higher hospital charges ($23,488 versus $19,260, p = 0.08), and higher radiology charges ($3,385 versus $1,711, p < 0.0001). The presence of common bile duct stone(s) on ultrasound was the only independent factor associated with less use of MRCP (OR 0.09, p < 0.0001). Conclusions. MRCP use prior to ERCP in patients at high risk for choledocholithiasis is common and associated with greater length of hospital stay, higher radiology charges, and a trend towards higher hospital charges.
Collapse
|
9
|
Arrivé L, Hodoul M, Arbache A, Slavikova-Boucher L, Menu Y, El Mouhadi S. Magnetic resonance cholangiography: Current and future perspectives. Clin Res Hepatol Gastroenterol 2015; 39:659-64. [PMID: 26275724 DOI: 10.1016/j.clinre.2015.07.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/09/2015] [Accepted: 07/15/2015] [Indexed: 02/04/2023]
Abstract
Magnetic resonance cholangiography (MRC) has become the standard of reference for imaging of the biliary ducts. The use of three-dimensional (3D) sequences has resulted in improved spatial resolution with virtually isotropic voxel and improved signal/noise ratio. In addition to MRC images, 3D fat suppressed T1-weighted MR images should be systematically obtained to search for intrahepatic calculi. MRC plays a major role in the diagnosis of cholangiocarcinoma and assessment of its resectability. With modern MR systems the performance of MR is basically the same that of CT for evaluation of arterial and portal vein extent. MRC is a key imaging modality for the diagnosis of primary sclerosing cholangitis. Different imaging patterns may be observed including multifocal intra- and extrahepatic strictures alternating with slightly dilated ducts. Focal signal abnormality of the liver parenchyma and focal parenchymal atrophy represent the consequences of biliary duct obstruction on liver parenchyma. Diagnosis of biliary lithiasis is performed by combination of MRC and T1-weighted MR imaging. MRC can be performed for the diagnosis of secondary cholangitis including ascending cholangitis, ischemic cholangitis and IgG4-related sclerosing cholangitis. Hepatobiliary contrast agents could be used for demonstrating the site of biliary duct leakage after surgery and for functional imaging. MR imaging can also be used to determine the prognosis of PSC. The inherent limitations of MRC of bile ducts are still the suboptimal spatial resolution for evaluation of distal intrahepatic biliary ducts.
Collapse
Affiliation(s)
- Lionel Arrivé
- Department of Radiology, Sorbonne Universités, UPMC University Paris 06, Saint-Antoine Hospital, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
| | - Marianne Hodoul
- Department of Radiology, Sorbonne Universités, UPMC University Paris 06, Saint-Antoine Hospital, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Antoune Arbache
- Department of Radiology, Sorbonne Universités, UPMC University Paris 06, Saint-Antoine Hospital, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Lucie Slavikova-Boucher
- Department of Radiology, Sorbonne Universités, UPMC University Paris 06, Saint-Antoine Hospital, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Yves Menu
- Department of Radiology, Sorbonne Universités, UPMC University Paris 06, Saint-Antoine Hospital, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Sanaâ El Mouhadi
- Department of Radiology, Sorbonne Universités, UPMC University Paris 06, Saint-Antoine Hospital, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| |
Collapse
|
10
|
Abstract
Background Acute bacterial cholangitis for the most part owing to common bile duct stones is common in gastroenterology practice and represents a potentially life-threatening condition often characterized by fever, abdominal pain, and jaundice (Charcot's triad) as well as confusion and septic shock (Reynolds' pentad). Methods This review is based on a systematic literature review in PubMed with the search items ‘cholangitis’, ‘choledocholithiasis’, ‘gallstone disease’, ‘biliary infection’, and ‘biliary sepsis’. Results Although most patients respond to empiric broad-spectrum antibiotic treatment, timely endoscopic biliary drainage depending on the severity of the disease is required to eliminate the underlying obstruction. Specific recommendations have been derived from the Tokyo guideline working group consensus 2006 and its update in 2013, albeit poorly evidence-based, providing a comprehensive overview of diagnosis, classification, risk stratification, and treatment algorithms in acute bacterial cholangitis. Conclusion Prompt clinical recognition and accurate diagnostic workup including adequate laboratory assessment and (aetiology-oriented) imaging are critical steps in the management of cholangitis. Treatment is directed at the two major interrelated pathophysiologic components, i.e. bacterial infection (immediate antimicrobial therapy) and bile duct obstruction (biliary drainage). As for the latter, transpapillary endoscopic drainage by stent or nasobiliary drain and/or same-session bile duct clearance, depending on individual disease severity, represent first-line treatment approaches.
Collapse
Affiliation(s)
- Vincent Zimmer
- Department of Medicine II, Saarland University Medical Center, Homburg/Saar, Germany
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Homburg/Saar, Germany
| |
Collapse
|
11
|
Giljaca V, Gurusamy KS, Takwoingi Y, Higgie D, Poropat G, Štimac D, Davidson BR. Endoscopic ultrasound versus magnetic resonance cholangiopancreatography for common bile duct stones. Cochrane Database Syst Rev 2015; 2015:CD011549. [PMID: 25719224 PMCID: PMC6464848 DOI: 10.1002/14651858.cd011549] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Endoscopic ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP) are tests used in the diagnosis of common bile duct stones in patients suspected of having common bile duct stones prior to undergoing invasive treatment. There has been no systematic review of the accuracy of EUS and MRCP in the diagnosis of common bile duct stones using appropriate reference standards. OBJECTIVES To determine and compare the accuracy of EUS and MRCP for the diagnosis of common bile duct stones. SEARCH METHODS We searched MEDLINE, EMBASE, Science Citation Index Expanded, BIOSIS, and Clinicaltrials.gov until September 2012. We searched the references of included studies to identify further studies and of systematic reviews identified from various databases (Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment (HTA), Medion, and ARIF (Aggressive Research Intelligence Facility)). We did not restrict studies based on language or publication status, or whether data were collected prospectively or retrospectively. SELECTION CRITERIA We included studies that provided the number of true positives, false positives, false negatives, and true negatives for EUS or MRCP. We only accepted studies that confirmed the presence of common bile duct stones by extraction of the stones (irrespective of whether this was done by surgical or endoscopic methods) for a positive test, and absence of common bile duct stones by surgical or endoscopic negative exploration of the common bile duct or symptom free follow-up for at least six months for a negative test, as the reference standard in people suspected of having common bile duct stones. We included participants with or without prior diagnosis of cholelithiasis; with or without symptoms and complications of common bile duct stones, with or without prior treatment for common bile duct stones; and before or after cholecystectomy. At least two authors independently screened abstracts and selected studies for inclusion. DATA COLLECTION AND ANALYSIS Two authors independently collected the data from each study. We used the bivariate model to obtain pooled estimates of sensitivity and specificity. MAIN RESULTS We included a total of 18 studies involving 2366 participants (976 participants with common bile duct stones and 1390 participants without common bile duct stones). Eleven studies evaluated EUS alone, and five studies evaluated MRCP alone. Two studies evaluated both tests. Most studies included patients who were suspected of having common bile duct stones based on abnormal liver function tests; abnormal transabdominal ultrasound; symptoms such as obstructive jaundice, cholangitis, or pancreatitis; or a combination of the above. The proportion of participants who had undergone cholecystectomy varied across studies. Not one of the studies was of high methodological quality. For EUS, the sensitivities ranged between 0.75 and 1.00 and the specificities ranged between 0.85 and 1.00. The summary sensitivity (95% confidence interval (CI)) and specificity (95% CI) of the 13 studies that evaluated EUS (1537 participants; 686 cases and 851 participants without common bile duct stones) were 0.95 (95% CI 0.91 to 0.97) and 0.97 (95% CI 0.94 to 0.99). For MRCP, the sensitivities ranged between 0.77 and 1.00 and the specificities ranged between 0.73 and 0.99. The summary sensitivity and specificity of the seven studies that evaluated MRCP (996 participants; 361 cases and 635 participants without common bile duct stones) were 0.93 (95% CI 0.87 to 0.96) and 0.96 (95% CI 0.90 to 0.98). There was no evidence of a difference in sensitivity or specificity between EUS and MRCP (P value = 0.5). From the included studies, at the median pre-test probability of common bile duct stones of 41% the post-test probabilities (with 95% CI) associated with positive and negative EUS test results were 0.96 (95% CI 0.92 to 0.98) and 0.03 (95% CI 0.02 to 0.06). At the same pre-test probability, the post-test probabilities associated with positive and negative MRCP test results were 0.94 (95% CI 0.87 to 0.97) and 0.05 (95% CI 0.03 to 0.09). AUTHORS' CONCLUSIONS Both EUS and MRCP have high diagnostic accuracy for detection of common bile duct stones. People with positive EUS or MRCP should undergo endoscopic or surgical extraction of common bile duct stones and those with negative EUS or MRCP do not need further invasive tests. However, if the symptoms persist, further investigations will be indicated. The two tests are similar in terms of diagnostic accuracy and the choice of which test to use will be informed by availability and contra-indications to each test. However, it should be noted that the results are based on studies of poor methodological quality and so the results should be interpreted with caution. Further studies that are of high methodological quality are necessary to determine the diagnostic accuracy of EUS and MRCP for the diagnosis of common bile duct stones.
Collapse
Affiliation(s)
- Vanja Giljaca
- Clinical Hospital Centre RijekaDepartment of GastroenterologyKresimirova 42RijekaCroatia51000
| | - Kurinchi Selvan Gurusamy
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRoyal Free HospitalRowland Hill StreetLondonUKNW3 2PF
| | - Yemisi Takwoingi
- University of BirminghamPublic Health, Epidemiology and BiostatisticsEdgbastonBirminghamUKB15 2TT
| | - David Higgie
- North Bristol NHS TrustFrenchay HospitalBristolUKBS16 1LE
| | - Goran Poropat
- Clinical Hospital Centre RijekaDepartment of GastroenterologyKresimirova 42RijekaCroatia51000
| | - Davor Štimac
- Clinical Hospital Centre RijekaDepartment of GastroenterologyKresimirova 42RijekaCroatia51000
| | - Brian R Davidson
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRoyal Free HospitalRowland Hill StreetLondonUKNW3 2PF
| | | |
Collapse
|
12
|
Body mass index, cholecystitis, cholelithiasis, pancreatitis and imaging of common bile duct stones. Am J Med Sci 2014; 347:364-9. [PMID: 23838577 DOI: 10.1097/maj.0b013e318296a6fe] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE Studies to date have not investigated whether body mass index (BMI) affects the sensitivity and specificity of magnetic resonance cholangiopancreatography (MRCP). The purpose of this study was to investigate the effect of BMI and also concomitant pancreatitis, cholecystitis and cholelithiasis on the sensitivity and specificity of MRCP. MATERIALS AND METHODS Between January 2004 and December 2011, 185 patients were included in the study and divided into 3 groups according to BMI as normal, overweight or obese. Both MRCP and endoscopic retrograde cholangiopancreatography (ERCP) were performed in all patients. ERCP was accepted as the "gold standard." The accuracy, sensitivity and specificity values of the 3 groups were calculated to determine any effects on the results of the MRCP. RESULTS Before separating into groups according to BMI, the statistical results for MRCP in the detection of stone disease were as follows: specificity 74.3%, sensitivity 81.7% and accuracy 79%. After dividing the patients into 3 groups according to BMI, the specificity of stone detection with MRCP in the normal-weight group was 93.8% but decreased to 65.5% in the overweight group and to 72% in the obese group. The sensitivity of stone detection with MRCP in the normal-weight group was 85.2% but decreased to 75% in the overweight group and increased to 88.9% in the obese group. The accuracy was 88.3% in the normal-weight group but decreased to 71.6% in the overweight group and to 81.9% in the obese group. CONCLUSION Our study showed that MRCP performance was decreased in the overweight and obese groups.
Collapse
|
13
|
Mandelia A, Gupta AK, Verma DK, Sharma S. The Value of Magnetic Resonance Cholangio-Pancreatography (MRCP) in the Detection of Choledocholithiasis. J Clin Diagn Res 2013; 7:1941-5. [PMID: 24179904 DOI: 10.7860/jcdr/2013/6158.3365] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 07/01/2013] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Magnetic Resonance Cholangio-Pancreatography (MRCP) is a non-invasive radiological investigation which can be performed rapidly and which does not expose the patients to ionised radiations or iodinated contrast material. The present study was conducted to evaluate the role of MRCP in detection of Common Bile Duct (CBD) stones in patients with suspected choledocholithiasis. MATERIAL AND METHODS This prospective study included 30 patients with a suspicion of choledocholithiasis which was based on clinical evaluation, biochemical or radiological investigations. Ultrasonography and MRCP were performed in all patients. All patients underwent open surgery. CBD exploration was performed in all patients, either due to presence of palpable stones or due to the presence of dilated CBD (> 7 mm). Demonstration of CBD stones intra-operatively was considered the 'gold standard' for their presence, defined as stones visualised and extracted or attempted for extraction during surgical CBD exploration. RESULTS Intra-operatively, 21 (70%) out of 30 patients had cholelithiasis. 26 (86.67%) out of 30 patients had dilated CBD stones intra-operatively. In 20 (66.67%) out of 30 patients, choledocholithiasis was detected intra-operatively. The sensitivity, specificity, positive and negative predictive value of ultrasonography in detecting CBD stones in the present study was 65%, 60%, 76.47% and 46.15% respectively. The sensitivity, specificity, positive and negative predictive value of MRCP in diagnosis of CBD stones in the present study was 95%, 90%, 95% and 90% respectively. CONCLUSIONS MRCP is a non-invasive investigation without complications and it has high sensitivity, specificity and positive and negative predictive values in detection of CBD stones. MRCP should be done in all cases with a suspicion of CBD stones, where facilities and expertise are available.
Collapse
Affiliation(s)
- Ankur Mandelia
- Senior Resident, Department of Paediatric Surgery, All India Institute of Medical Sciences , New Delhi 110029, India
| | | | | | | |
Collapse
|
14
|
Preoperative MRCP to detect choledocholithiasis in acute calculous cholecystitis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 19:458-64. [PMID: 21983892 PMCID: PMC3399076 DOI: 10.1007/s00534-011-0456-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE There are risks of common bile duct (CBD) stones in acute cholecystitis, and there is a move among surgeons to identify choledocholithiasis before surgery. Magnetic resonance cholangiopancreaticography (MRCP) has the potential to accurately detect choledocholithiasis in patients with acute cholecystitis. The aim of this study was to evaluate the predictive values of MRCP and elevated biochemical predictors for choledocholithiasis in patients with acute cholecystitis. METHODS Between September 2006 and August 2008, of 84 patients with acute cholecystitis based on the diagnosis criteria of the Tokyo guidelines, 57 had MRCP preoperatively. The predictive values of six biochemical predictors for choledocholithiasis were also evaluated. RESULTS Of the 57 patients, seven (12.28%) had choledocholithiasis, of whom three had CBD stones in nondilated ducts. The smallest stone detected in a dilated CBD and nondilated duct was 3.19 and 4.55 mm in diameter, respectively. None of our patients whose MRCP showed a clear CBD returned with symptomatic choledocholithiasis during the follow-up period. All biochemical predictors and CBD diameter had limited positive predictive values. CONCLUSIONS Magnetic resonance cholangiopancreaticography is a reliable evaluation technique for the detection of choledocholithiasis. It reduces the misdiagnosis of retained choledocholithiasis with normal biochemical predictors and prevents the risk of overlooking choledocholithiasis. No single predictor or combined markers have been found to be reliable for including/excluding the presence of choledocholithiasis.
Collapse
|
15
|
Daneze ER, Terra GA, Terra JA, Campos AGD, Silva AAD, Terra SA. Comparative study between ligature with thread or metallic clamping by means of laparoscopy with the purpose of experimental biliary obstruction in swines. Acta Cir Bras 2012; 26 Suppl 2:31-7. [PMID: 22030812 DOI: 10.1590/s0102-86502011000800007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To induce a total extra-hepatic obstructive jaundice in swines, by ligation of the common bile duct by laparoscopic surgery. METHODS Eight swines of the Landrace race, 36-day-old, originated from the same matrix, distributed in two groups. Group A: was used titanium metal clip to the common bile duct ligation in three animals; group B: were ligated with 2-0 cotton thread in five animals. RESULTS The ligation of the biliary ducts was performed successfully in all animals, with easy identification of the common bile duct by laparoscopy. There weren't difficulties in the procedures, mainly due to the increased surgical field provided by the excellent quality of light and image of the appliance. The clinical signs of jaundice were evident in the animals in seven days. In group A, two animals showed bile duct perforation near the clip, probably due to ischemic necrosis, progressing to peritonitis and death. In group B, five animals showed obstructive jaundice without any amendment. CONCLUSION Under the conditions of this study, we therefore recommend the use of unabsorbed wires to experimental biliary obstruction, in order to avoid complications, such as ischemia and necrosis, followed by perforation of the wall of the bile ducts.
Collapse
|
16
|
Mou Y, Zhou H, Xu B. Single gigantic calculus of common bile duct and multiple hepatolithiasis. Am J Surg 2011; 202:e38-40. [PMID: 21824601 DOI: 10.1016/j.amjsurg.2010.07.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 07/24/2010] [Accepted: 07/24/2010] [Indexed: 11/27/2022]
Abstract
Choledocholithiasis is a very common surgical disease worldwide. Reports of a single calculus of the common bile duct >10 cm are very rare. The authors present a case of a single gigantic calculus in the common bile duct with multiple stones distributing in the left intrahepatic ducts. The patient was treated with left hemihepatectomy combined with Roux-en-Y hepaticojejunostomy, and the postoperative course was uneventful. Left hemihepatectomy combined with Roux-en-Y hepaticojejunostomy was the optimal treatment for this patient, with a satisfactory outcome.
Collapse
Affiliation(s)
- Yiping Mou
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | | | | |
Collapse
|
17
|
Advances in hepatobiliary surgery. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2011. [DOI: 10.1016/j.tacc.2010.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
18
|
Frossard JL, Morel PM. Detection and management of bile duct stones. Gastrointest Endosc 2010; 72:808-16. [PMID: 20883860 DOI: 10.1016/j.gie.2010.06.033] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Accepted: 06/10/2010] [Indexed: 12/13/2022]
Affiliation(s)
- Jean Louis Frossard
- Gastroenterology and Digestive Surgery Service, Hôpitaux Universitaires de Genève, Université de Genève, Geneva, Switzerland
| | | |
Collapse
|
19
|
Abstract
Bacterial infection that occurs in the setting of biliary obstruction can lead to acute cholangitis, a condition characterized by fever, abdominal pain and jaundice. Choledocholithiasis is the most common cause of acute cholangitis and is often associated with bacterial infection and colonization in addition to biliary obstruction. Iatrogenic introduction of bacteria into the biliary system most commonly occurs during endoscopic retrograde cholangiopancreatography in patients with biliary obstruction. The majority of patients with acute cholangitis respond to antibiotic therapy, but endoscopic biliary drainage is ultimately required to treat the underlying obstruction. Acute cholangitis is often diagnosed using the clinical Charcot triad criteria; however, recommendations from an international consensus meeting in Tokyo produced the most comprehensive recommendations for the diagnosis and management of acute cholangitis. These guidelines enable a more accurate diagnosis of acute cholangitis than do earlier methods, and they facilitate the classification of disease as mild, moderate or severe. Although these guidelines represent a notable advance toward defining a universally accepted consensus for the definition of acute cholangitis, they have several limitations. This Review discusses current recommendations for the diagnosis of acute cholangitis and addresses the advantages and disadvantages of different modalities for the treatment of this disease.
Collapse
Affiliation(s)
- John G Lee
- University of California Irvine Medical Center, 101 The City Drive, Building 53, Room 113, Orange, CA 92868, USA.
| |
Collapse
|
20
|
Maluf-Filho F, Dotti CM, Farias AQ, Kupski C, Chaves DM, Artifon E, Nakao F, Rossini GF, Paulo GAD, Ardengh JC, Silva JEFD, Rossini L, Lima LFPD, Averbach M, Cury MS, D'Aassunção MA, Silva MC, Ney MV, Spinosa S, Matuguma SE, Guaraldi S, Arantes V, Mello VH. [I Brazilian consensus of endoscopic ultrasonography]. ARQUIVOS DE GASTROENTEROLOGIA 2008; 44:353-8. [PMID: 18317657 DOI: 10.1590/s0004-28032007000400014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Accepted: 10/12/2007] [Indexed: 12/12/2022]
Abstract
BACKGROUND In the last 20 years, several papers have focused on demonstrating the impact of endoscopic ultrasonography findings on the management of different clinical scenarios in digestive disease. This fact is an indirect evidence of the difficulty of popularization of the method. On other hand, the limited availability of endoscopic ultrasonography in Brazil is a direct evidence of this limitation. This was the rationale for the organization of a consensus meeting on endoscopic ultrasonography. It was aimed to identify the best evidence that support the use of endoscopic ultrasonography in gastroenterology. METHODS A panel of experts on endoscopic ultrasonography was selected based on the files of the Gastroenterology and Endoscopy Societies and on the registries of endoscope manufacturers. Two members of the meeting selected the relevant topics that were transformed into questions. The topics and the questions were debated among the experts five months before the consensus meeting. The experts were asked to perform systematic reviews in order to answer the questions so it could be possible to grade the answers based on the strength of the evidence. During the two days of the meeting the answers were presented, debated and voted. Consensus was reached when a minimum of 70% of the voters were in agreement. The final consensus report was submitted to the experts' evaluation and approval. RESULTS Seventy nine questions were debated by the experts at the pre-Consensus meeting. As the result of this debate 85 questions came out and were assigned to the members of the panel. During the Consensus meeting 22 experts debated and voted 85 answers. Consensus was reached for several clinical scenarios for which the impact of endoscopic ultrasonography findings were supported by level 1 evidences: differential diagnosis of subepithelial lesions and thickening of gastric folds, staging and diagnosis of unresectable esophageal cancer, indirect signs of peritoneal involvement of gastric cancer, MALT gastric lymphoma and rectal cancer staging, diagnosis of common bile duct and gallbladder stones, diagnosis of chronic pancreatitis and differential diagnosis of a solid mass in chronic pancreatitis, differential diagnosis of the pancreatic cyst, prediction of the results of the endoscopic treatment of esophageal varices and diagnosis and staging of non-small cell lung cancer. CONCLUSIONS There are the highest levels of evidences that support the indication of endoscopic ultrasonography for several digestive diseases and even for non-small cell lung cancer.
Collapse
|
21
|
Is routine MR cholangiopancreatography (MRCP) justified prior to cholecystectomy? Langenbecks Arch Surg 2008; 394:1005-10. [PMID: 19084990 DOI: 10.1007/s00423-008-0447-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2008] [Accepted: 09/16/2008] [Indexed: 12/20/2022]
Abstract
PURPOSE We investigated routinely the bile ducts by magnetic resonance cholangiopancreaticography (MRCP) prior to cholecystectomy. The aim of this study was to analyze the rate of clinically inapparent common bile duct (CBD) stones, the predictive value of elevated liver enzymes for CBD stones, and the influence of the radiological results on the perioperative management. METHODS In this prospective study, 465 patients were cholecystectomized within 18 months, mainly laparoscopically. Preoperative MRCP was performed in 454 patients. RESULTS With MRCP screening, clinically silent CBD stones were found in 4%. Elevated liver enzymes have only a poor predictive value for the presence of CBD stones (positive predictive value, 21%; negative predictive value, 96%). Compared to the recent literature, the postoperative morbidity in this study was low (0 bile duct injury, 0.4% residual gallstones). CONCLUSIONS Although MRCP is diagnostically useful in the perioperative management in some cases, its routine use in the DRG-era may not be justified due to the costs.
Collapse
|
22
|
Verbesey JE, Birkett DH. Common Bile Duct Exploration for Choledocholithiasis. Surg Clin North Am 2008; 88:1315-28, ix. [DOI: 10.1016/j.suc.2008.08.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
23
|
Abstract
Work in progress
Collapse
Affiliation(s)
- J Stoker
- Department of Radiology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| |
Collapse
|
24
|
Sahni VA, Mortele KJ. Magnetic resonance cholangiopancreatography: current use and future applications. Clin Gastroenterol Hepatol 2008; 6:967-77. [PMID: 18774532 DOI: 10.1016/j.cgh.2008.05.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Revised: 05/13/2008] [Accepted: 05/24/2008] [Indexed: 02/07/2023]
Abstract
Magnetic resonance pancreatography (MRCP) is now established as a robust noninvasive tool for the evaluation of biliary and pancreatic pathology. Its diagnostic performance is comparable with endoscopic retrograde cholangiopancreatography without the associated risks. This article aims to familiarize the reader with the technique, clinical indications, and limitations of the investigation. Common pitfalls in interpretation also are addressed. Emerging applications and techniques are discussed that include recent advances in technology and the development of functional imaging.
Collapse
Affiliation(s)
- Vikram A Sahni
- Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
| | | |
Collapse
|
25
|
Brekalo Z, Innocenti P, Duzel G, Liddo G, Ballone E, Simunović VJ. Ten years of laparoscopic cholecystectomy: a comparison between a developed and a less developed country. Wien Klin Wochenschr 2008; 119:722-8. [PMID: 18157606 DOI: 10.1007/s00508-007-0906-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Accepted: 08/27/2007] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To compare the specific features and outcomes of laparoscopic cholecystectomy in two university hospitals, one in a developing country, Bosnia-Herzegovina, and the other in a well developed country, Italy. METHODS Between January 1996 and December 2005, a total of 2018 patients underwent laparoscopic cholecystectomy in Mostar Clinical Hospital, Bosnia-Herzegovina (1066) and in Chieti University Hospital, Chieti, Italy (952). Differences in patients' presentations, diagnostic protocols, medication, surgical treatment, complications and outcomes were analyzed. RESULTS The number of patients with life-threatening conditions was lower in Italy (15 or 1.5% vs. 53 or 4.9%; P<0.001), as was the use of analgesia and antibiotics (131 or 13.96% vs. 873 or 81.97%; P<0.001). Open-access biliary surgery was rare in Italy, where the vast majority of patients were operated laparoscopically; only 44 (4.41%) patients had open-access surgery, including 35 (3.61%) conversion patients. In comparison, 1669 (61%) patients in Bosnia-Herzegovina underwent open-access operations. There was a significant difference, in favor of the Italian hospital, in the number of surgical complications (8 or 0.84% vs. 40 or 3.75%; P<0.002) and also in the number of postoperative infections following surgical incision (0 or 0.0% vs. 6 or 0.56%; P<0.033). CONCLUSIONS It is encouraging for surgeons in Bosnia-Herzegovina to find that satisfactory results can be achieved in a developing country. However, the number of complications encountered in the Mostar hospital emphasizes the need for further improvement of surgical technique through better structured training combined with strict supervision of junior staff. The finding of postoperative infections in the Bosnia-Herzegovina hospital, despite that their occurrence was relatively rare, highlights the necessity for further improvement of hospital infection control.
Collapse
Affiliation(s)
- Zdrinko Brekalo
- Mostar Clinical Hospital and School of Medicine, Mostar University, Mostar, Bosnia-Herzegovina
| | | | | | | | | | | |
Collapse
|
26
|
Clinical models are inaccurate in predicting bile duct stones in situ for patients with gallbladder. Surg Endosc 2008; 23:38-44. [DOI: 10.1007/s00464-008-9868-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2007] [Revised: 12/21/2007] [Accepted: 01/18/2008] [Indexed: 12/20/2022]
|
27
|
Guerra-Filho V, Nunes TA, Araújo ID. Perioperative fluorocholangiography with routine indication versus selective indication in laparoscopic cholecystectomy. ARQUIVOS DE GASTROENTEROLOGIA 2007; 44:271-5. [DOI: 10.1590/s0004-28032007000300017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2006] [Accepted: 05/10/2007] [Indexed: 11/22/2022]
Abstract
BACKGROUND: The use of routine or selective peroperatory cholangiography in cholecystectomy is a matter of controversy in literature. AIM: To compare the efficacy of selective or routine fluorocholangiography in diagnostic of common bile duct stone in patients underwent to laparoscopic cholecystectomy based on selective indication criteria. METHOD: Two hundred and fifty four patients with cholelithiasis were prospectively studied. The patients were divided in two groups: to the first 127 patients perioperative fluorocholangiography was indicated as routine (group 1), and to the other 127 patients perioperative fluorocholangiography indication followed clinical criteria (jaundice, choluria, fecal acholia and history of pancreatitis), laboratory criteria (increase in seric alkaline phosphatase, bilirubins, amylase) or ultra-sonographyc criteria (less than 6 mm diameter calculi, common bile duct stone, common bile duct diameter more than 6 mm). A comparative assessment of the difference in common bile duct stone diagnosis, fluorocholangiography success index and reliability of the selective criteria of indication for perioperative fluorocholangiography was compared between the two groups. RESULTS: Perioperative fluorocholangiography was successfully performed in 102 of the 127 patients from group 1 (a rate of 80.3%), and in 59 of the 71 patients from group 2 (a rate of 83.1%). In the 102 patients of group 1 who underwent perioperative fluorocholangiography, 11 (10.8%) presented common bile duct stone, 4 (3.9%) presented common bile duct dilatation, and 1 (1%) had a false-positive image. In the 59 patients from group 2, 7 (11.7%) presented common bile duct stone and one (1.7%) presented a common bile duct diatation. In another situation, when application of selective indication criteria to perioperative fluorocholangiography was simulated in group 1 patients, we observed that only in one patient with common bile duct stone the diagnostic would not have been made. Fluorocholangiography selective indication criteria presented sensitivity of 90.9% and specificity of 46.2%. The main causes of fluorocholangiography failure were biliary pedicle inflammation and cystic duct size and caliber variations. CONCLUSION: There was not a significant difference in common bile duct stone diagnostic through perioperative fluorocholangiography between the groups of patients with selective and routine indication, validating the examination selective indication criteria, with a sensitivity of 90.9%, despite the specificity of 46.2 % - 43 patients were selected to the flourocholangiography and common bile duct stone was not diagnosed.
Collapse
|
28
|
Mercer S, Singh S, Paterson I. Selective MRCP in the management of suspected common bile duct stones. HPB (Oxford) 2007; 9:125-30. [PMID: 18333127 PMCID: PMC2020789 DOI: 10.1080/13651820701216190] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Indexed: 12/12/2022]
Abstract
BACKGROUND It is controversial whether selective endoscopic sphincterotomy or routine laparoscopic bile duct exploration is the optimal treatment for choledocholithiasis. Magnetic resonance cholangio-pancreatography (MRCP) is a safe and accurate imaging modality; this study evaluated its use in a clinical algorithm for the management of suspected choledocholithiasis. PATIENTS AND METHODS Consecutive patients presenting with suspected common bile duct (CBD) stones were managed according to an algorithm involving the selective use of MRCP to identify patients who required endoscopic sphincterotomy and bile duct clearance. Following radiological demonstration of a clear CBD, all patients were considered for cholecystectomy. RESULTS From 157 consecutive patients, 68 proceeded straight to endoscopic sphincterotomy, which was therapeutic in 59. Of 89 who underwent MRCP, choledocholithiasis was demonstrated in 29; subsequent endoscopic sphincterotomy was therapeutic in 22. MRCP demonstrated a clear CBD in the remaining 60 patients. Seventy-four patients subsequently underwent cholecystectomy, with a conversion rate of 9% and a median postoperative stay of 1 day. There were no instances of post-sphincterotomy pancreatitis or haemorrhage requiring transfusion. CONCLUSION An algorithm involving selective MRCP with endoscopic sphincterotomy is a safe, effective means of managing suspected choledocholithiasis, particularly where the expertise, equipment or theatre time for laparoscopic bile duct exploration is not routinely available.
Collapse
|
29
|
Kaltenthaler EC, Walters SJ, Chilcott J, Blakeborough A, Vergel YB, Thomas S. MRCP compared to diagnostic ERCP for diagnosis when biliary obstruction is suspected: a systematic review. BMC Med Imaging 2006; 6:9. [PMID: 16907974 PMCID: PMC1579209 DOI: 10.1186/1471-2342-6-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2006] [Accepted: 08/14/2006] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Magnetic resonance cholangiopancreatography (MRCP) is an alternative to diagnostic endoscopic retrograde cholangiopancreatography (ERCP) for investigating biliary obstruction. The use of MRCP, a non-invasive procedure, may prevent the use of unnecessary invasive procedures. The aim of the study was to compare the findings of MRCP with those of ERCP by the computation of accuracy statistics. METHODS Thirteen electronic bibliographic databases, covering biomedical, science, health economics and grey literature were searched. A systematic review of studies comparing MRCP to diagnostic ERCP in patients with suspected biliary obstruction was conducted. Sensitivity, specificity, likelihood ratios, acceptability and adverse events were reported. RESULTS 25 studies were identified reporting several conditions including choledocholithiasis (18 studies), malignancy (four studies), obstruction (three studies), stricture (two studies) and dilatation (five studies). Three of the 18 studies reporting choledocholithiasis were excluded from the analysis due to lack of data, or differences in study design. The sensitivity for the 15 studies of choledocholithiasis ranged from 0.50 to 1.00 while specificity ranged from 0.83 to 1.00. The positive likelihood ratio ranged: from 5.44-47.72 and the negative likelihood ratio for the 15 studies ranged from 0.00-0.51. Significant heterogeneity was found across the 15 studies so the sensitivities and specificities were summarised by a Receiver Operating Characteristic (ROC) curve. For malignancy, sensitivity ranged from 0.81 to 0.94 and specificity from 0.92 to 1.00. Positive likelihood ratios ranged from 10.12 to 43 and negative likelihood ratios ranged from 0.15 to 0.21, although these estimates were less reliable. CONCLUSION MRCP is a comparable diagnostic investigation in comparison to ERCP for diagnosing biliary obstruction.
Collapse
Affiliation(s)
- Eva C Kaltenthaler
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Stephen J Walters
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Jim Chilcott
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | | | | | - Steven Thomas
- Northern General Hospital, Herries Road, Sheffield S5 7AU, UK
| |
Collapse
|
30
|
Miletic D, Uravic M, Mazur-Brbac M, Stimac D, Petranovic D, Sestan B. Role of Magnetic Resonance Cholangiography in the Diagnosis of Bile Duct Lithiasis. World J Surg 2006; 30:1705-12. [PMID: 16850153 DOI: 10.1007/s00268-005-0459-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AIM The aim of our study was to assess diagnostic value of magnetic resonance cholangiography (MRC) in patients with suspected common bile duct (CBD) stones focusing on the capability of this noninvasive method to replace invasive diagnostic procedures in these patients and to limit the use of endoscopic retrograde cholangiography (ERC) to the patients who need simultaneous therapeutic intervention. MATERIALS AND METHODS Single-shot fast-spin-echo rapid-acquisition thick-section MRC images were obtained in 310 patients recruited into this prospective study. There were 136 male and 174 female patients aged 21-95 years [mean +/- standard deviation (SD) 64.9 +/- 13.6 years]. Patients were subsequently classified into different risk groups (high, moderate, low) according to biochemical abnormalities or morphological features on abdominal ultrasonography and computed tomography. Direct cholangiography was the reference method of CBD evaluation. RESULTS CBD stones were diagnosed in 115 (37%) patients; 86 of 175 patients in the high-risk group, 24 of 83 patients in the moderate-risk group, and 5 of 50 patients in the low-risk group. In dependent risk groups, the mean CBD caliber was 9.7 +/- 4.5, 7.1 +/- 2.0, and 4.8 +/- 1.2 mm, respectively. The difference was significant between all three groups (P < 0.05). The median size of CBD stones was 7 mm (range 3-21 mm). MRC achieved accuracy and positive and negative predictive values of 97%, 94%, and 98%, respectively. CONCLUSIONS MRC has a potential to substitute diagnostic ERC in all patients with suspected choledocholithiasis due to its high accuracy, reducing invasive direct cholangiography to patients who require therapeutic intervention.
Collapse
|
31
|
Vergel YB, Chilcott J, Kaltenthaler E, Walters S, Blakeborough A, Thomas S. Economic evaluation of MR cholangiopancreatography compared to diagnostic ERCP for the investigation of biliary tree obstruction. Int J Surg 2006; 4:12-9. [PMID: 17462309 DOI: 10.1016/j.ijsu.2006.01.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2005] [Revised: 01/10/2006] [Accepted: 01/16/2006] [Indexed: 10/25/2022]
Abstract
BACKGROUND Use of magnetic resonance cholangiopancreatography (MRCP) for confirmation of presence of biliary obstruction is virtually risk-free. However, unlike diagnostic endoscopic retrograde cholangiopancreatography (ERCP), no therapeutic option can be offered simultaneously with MRCP. The aim of the study is to assess the cost-effectiveness of MRCP when compared with the conventional practice of diagnostic ERCP for the investigation of biliary obstruction in adults. METHODS Cost-effectiveness analysis from the perspective of the health care provider. Sensitivity analysis includes presentation of a family of cost effectiveness acceptability curves and the impact of different risks of common bile duct stones associated with ultrasound and liver function test results. The main outcome measure is cost per quality adjusted life year (QALY). RESULTS Baseline results, at 37% probability of common bile duct stones, show that MRCP is the dominant strategy, with expected savings of 149 pounds sterling (325 pounds sterling to - 15 pounds sterling) and expected QALY gain of 0.011 (0-0.030) per case. The probability of avoiding unnecessary therapeutic ERCP is 30%. For patients at high risk of common bile duct stones (probability >60%) ERCP is the preferable strategy. CONCLUSIONS The baseline estimate is that MRCP would be both cost saving and would result in improved quality of life outcomes compared to diagnostic ERCP, but its potential sources of economic benefit are highly dependent on access to, and waiting lists for adequate MRI technology at hospital level.
Collapse
Affiliation(s)
- Yolanda Bravo Vergel
- Department of Economics and Related Studies, Centre for Health Economics, University of York, Heslington, York YO10 5DD, UK.
| | | | | | | | | | | |
Collapse
|
32
|
Liu CL, Fan ST, Lo CM, Tso WK, Wong Y, Poon RTP, Lam CM, Wong BC, Wong J. Comparison of early endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography in the management of acute biliary pancreatitis: a prospective randomized study. Clin Gastroenterol Hepatol 2005; 3:1238-44. [PMID: 16361050 DOI: 10.1016/s1542-3565(05)00619-1] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The role and potential benefits of endoscopic ultrasonography (EUS) in the management of acute biliary pancreatitis have not been documented. We report a large prospective randomized study comparing early EUS and endoscopic retrograde cholangiopancreatography (ERCP) in the management of these patients. METHODS A prospective randomized study was performed on 140 patients with acute pancreatitis suspected to have a biliary cause. The patients were randomized to have EUS (n = 70) or ERCP (n = 70) within 24 hours from admission. In the EUS group, when EUS detected choledocholithiasis, therapeutic ERCP was performed during the same endoscopy session. In the ERCP group, diagnostic ERCP was performed, followed by therapeutic endoscopy when choledocholithiasis was detected. RESULTS Examination of the biliary tree by EUS was successful in all patients in the EUS group, whereas cannulation of the common duct during ERCP was unsuccessful in 10 patients (14%) in the ERCP group (P = .001). Combined percutaneous ultrasonography and ERCP missed detection of cholelithiasis in 6 patients in the ERCP group. The overall morbidity rate was 7% in the EUS group, and that in the ERCP group was 14% (P = .172). The hospital stay and mortality rates were comparable in both groups. CONCLUSIONS In selected patients with acute biliary pancreatitis, EUS could safely replace diagnostic ERCP in the management for selecting patients with choledocholithiasis for therapeutic ERCP with a higher successful examination rate, a higher sensitivity in the detection of cholelithiasis, and a comparable morbidity rate.
Collapse
Affiliation(s)
- Chi Leung Liu
- Centre for the Study of Liver Disease, The University of Hong Kong, Hong Kong, China.
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Liu CL, Fan ST, Lo CM, Tso WK, Wong Y, Poon RTP, Lam CM, Wong BC, Wong J. Clinico-biochemical prediction of biliary cause of acute pancreatitis in the era of endoscopic ultrasonography. Aliment Pharmacol Ther 2005; 22:423-31. [PMID: 16128680 DOI: 10.1111/j.1365-2036.2005.02580.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Occult biliary stones escape detection on conventional investigations, and clinico-biochemical systems proposed for predicting biliary pancreatitis has low predictive values. AIM To evaluate the accuracy of clinico-biochemical parameters for prediction of biliary pancreatitis in patients undergoing endoscopic ultrasonography. METHODS Early endoscopic ultrasonography was performed on 139 patients presenting with acute pancreatitis within 24 h of admission. The aetiologies of all patients were determined after complete evaluations, and clinico-biochemical characteristics of patients with a biliary cause (biliary group) and non-biliary causes (non-biliary group) were compared. RESULTS Biliary pancreatitis was diagnosed in 107 patients and 32 patients had non-biliary causes. The biliary group belonged to a significantly older age group, had a female predominance, significantly more derangement of liver function and a higher incidence of severe attack of acute pancreatitis. On multivariate analysis, female sex, age >58 years and serum alanine aminotransferase >150 U/L were independent predictive factors for biliary cause of acute pancreatitis. Using these three factors for prediction of biliary cause, the sensitivity was 93% and overall accuracy was 85%. CONCLUSION Clinico-biochemical prediction for biliary cause of acute pancreatitis improves in the era of endoscopic ultrasonography with a higher sensitivity and overall accuracy. In centres where endoscopic ultrasonography is inaccessible or local expertise is unavailable, clinico-biochemical prediction of biliary cause of acute pancreatitis may provide a useful alternative in the initial management of this group of patients.
Collapse
Affiliation(s)
- C L Liu
- Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong, China.
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Hallal AH, Amortegui JD, Jeroukhimov IM, Casillas J, Schulman CI, Manning RJ, Habib FA, Lopez PP, Cohn SM, Sleeman D. Magnetic resonance cholangiopancreatography accurately detects common bile duct stones in resolving gallstone pancreatitis. J Am Coll Surg 2005; 200:869-75. [PMID: 15922197 DOI: 10.1016/j.jamcollsurg.2005.02.028] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2004] [Revised: 02/08/2005] [Accepted: 02/08/2005] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is controversy about the optimal method to detect common bile duct (CBD) stones in patients with mild resolving gallstone pancreatitis. The aim of this study was to evaluate magnetic resonance cholangiopancreatography (MRCP) in detecting choledocholithiasis in this group of patients. STUDY DESIGN A prospective randomized trial was conducted. Patients randomized to group 1 (n = 34) underwent laparoscopic cholecystectomy (LC) and intraoperative cholangiography (IOC). Those randomized to group 2 (n = 29) had preoperative MRCP, of these, patients with negative MRCP underwent LC and IOC, patients with positive MRCP had preoperative ERCP followed by LC. RESULTS Sixty-three patients were randomized (34 to group 1 and 29 to group 2). CBD stones were found in 5 patients in group 1. CBD exploration was performed in 2 patients, preoperative ERCP in 1, and postoperative ERCP in the other 2. MRCP showed CBD stones in 4 patients in group 2. There were two false-positive MRCPs. Four patients with a negative MRCP did not have IOC or ERCP, the remaining 21 patients with a negative MRCP had a negative IOC. The MRCP sensitivity was 100% (95% CI, 16-100%), specificity 91% (95% CI, 72-99%), positive predictive value 50% (95% CI, 7-93%), negative predictive value 100% (95% CI, 84-100%), and accuracy 92% (95% CI, 74-99%). CONCLUSIONS Patients with resolving gallstone pancreatitis and a negative MRCP do not need preoperative ERCP or IOC. Only patients with a positive MRCP will require preoperative ERCP.
Collapse
Affiliation(s)
- Ali H Hallal
- Dewitt Daughtry Family Department of Surgery, Division of Trauma and Surgical Critical Care, Ryder Trauma Center, University of Miami School of Medicine, Miami, FL 33101, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Kim YJ, Kim MJ, Kim KW, Chung JB, Lee WJ, Kim JH, Oh YT, Lim JS, Choi JY. Preoperative evaluation of common bile duct stones in patients with gallstone disease. AJR Am J Roentgenol 2005; 184:1854-9. [PMID: 15908542 DOI: 10.2214/ajr.184.6.01841854] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Our objective was to suggest criteria for selection of a preoperative diagnostic technique for patients with gallstone disease. CONCLUSION Use of MR cholangiography preferentially before laparoscopic cholecystectomy, on patients who have a moderate or high risk of common bile duct stones, can significantly reduce purely diagnostic endoscopic retrograde cholangiography.
Collapse
Affiliation(s)
- Young-Jin Kim
- Department of Diagnostic Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul 120-752, South Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Shamiyeh A, Lindner E, Danis J, Schwarzenlander K, Wayand W. Short- versus long-sequence MRI cholangiography for the preoperative imaging of the common bile duct in patients with cholecystolithiasis. Surg Endosc 2005; 19:1130-4. [PMID: 16021379 DOI: 10.1007/s00464-004-2167-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2004] [Accepted: 02/11/2005] [Indexed: 12/25/2022]
Abstract
BACKGROUND This study aimed to compare an 18-s fast spin echo magnetic resonance image sequence (coronal thick-section two-dimensional breathhold) with a three-dimensional axial and coronal thin-section sequence and its secondary reconstruction, and to assess its value in the diagnosis of bile duct pathologies, particularly common bile duct stones (CBDS) before laparoscopic cholecystectomy. METHODS This study prospectively included 72 patients. Because of protocol violations, 14 of these patients had to be excluded. Thus, 58 patients (29 Man and 29 women with a mean age of 51 years) who had cholecystolithiasis or suspected choledocholithiasis were evaluated. Magnetic resonance cholangiopancreatography (MRCP) was performed for all patients with a fast sequence (18 s) and a long sequence (coronal oblique and axial respiratory triggered; 16 min). Two radiologists, blinded with respect to diagnosis, evaluated all the radiographic images. The MRCP results were confirmed for all the patients: 20 by endoscopic retrograde cholangiopancreatography, 46 by intraoperative cholangiography, and 2 by percutaneous transhepatic cholangiography. RESULTS According to the findings, 16 patients (28%) had CBDS, 6 patients (10%) had common bile duct stenosis, and 36 patients (62%) had a clear bile duct. With regard to CBDS, the short sequence had 100% specificity, 94% sensitivity, and an overall accuracy of 98%. Its negative predictive value was 98%, and its positive predictive value was 100%. The long sequence had a specificity of 100% and a sensitivity of 100%. CONCLUSION Because of its high sensitivity and specifity, MRCP has the potential to be the diagnostic method of choice for CBD evaluation. The short sequence is not suitable for the diagnosis of all CBD pathologies, but in cases of suspected CBDS, more than 80% of the patients could be diagnosed correctly, and the complete sequence could be dropped.
Collapse
Affiliation(s)
- A Shamiyeh
- Ludwig Boltzmann Institute for Operative Laparoscopy, 2nd Surgical Department, Academic Teaching Hospital, Linz, Krankenhausstrasse 9, 4020 Linz, Austria.
| | | | | | | | | |
Collapse
|
37
|
Araújo Neto NP, Gonçalves JE, Bromberg SH, Guz B, Zanoto A. Predição da coledocolitíase pela associação de indicadores clínicos e laboratoriais em dois momentos do pré-operatório da colecistectomia. Rev Col Bras Cir 2005. [DOI: 10.1590/s0100-69912005000100010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: O propósito deste estudo foi determinar a probabilidade de ocorrência de coledocolitíase através do estudo da associação de indicadores clínicos e laboratoriais desta doença em dois momentos do pré-operatório de colecistectomia. MÉTODO: Entre março de 2001 e março de 2002, 48 pacientes consecutivos com colelitíase foram submetidos a colecistectomia e colangiografia intra-operatória (CIO). Os pacientes foram divididos em dois grupos, sendo o grupo A constituído por 13 pacientes com coledocolitíase e o grupo B por 35 pacientes sem esta doença. Os pacientes foram investigados quanto aos indicadores clínicos e laboratoriais da coledocolitíase, analisados em dois períodos, tomando como ponto de corte as 48 horas que precederam a cirurgia. Posteriormente, estes indicadores pré-operatórios foram associados na equação da regressão logística em diferentes combinações. RESULTADOS: Utilizando a equação da regressão logística, constatou-se que a associação de dois indicadores clínicos em ambos os períodos (icterícia e sinal de Murphy) e dois laboratoriais ( nível de corte da gama glutamil transpeptidase e bilirrubina direta 48 horas antes da cirurgia) foi a mais adequada para a predição da coledocolitíase. Os valores obtidos por esta equação mostraram concordância com os grupos A e B, de 95,6%, e discordância de 4,4% (p= 0,0000007 e k = 0,89). Esta equação mostrou sensibilidade de 92,3%, especificidade de 97,0%, valor preditivo positivo de 92,3% e valor preditivo negativo de 97%. Estes valores foram próximos aos obtidos pela CIO, que mostrou concordância com os grupos estudados de 95,8%, e discordância de 4,2% (k = 0,90). CONCLUSÃO: Considerando os resultados obtidos, recomenda-se a associação de indicadores da coledocolitíase na equação da regressão logística para estabelecer a probabilidade de ocorrer coledocolitíase associada à colelitíase. A utilização desta equação pode orientar melhor a conduta diagnóstica e terapêutica nesta doença.
Collapse
|
38
|
|
39
|
Millat B. The author replies. Surg Endosc 2004. [DOI: 10.1007/s00464-003-9306-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
40
|
Kow L. Magnetic resonance imaging in the diagnosis of choledocholithiasis. ANZ J Surg 2004; 74:618. [PMID: 15315556 DOI: 10.1111/j.1445-1433.2004.03171.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
41
|
Liu TH, Organ CH. Magnetic resonance cholangiography: applications in patients with calculus disease of the biliary tract. Asian J Surg 2004; 27:99-107. [PMID: 15140660 DOI: 10.1016/s1015-9584(09)60321-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Magnetic resonance cholangiography (MRC) is a non-invasive imaging modality that has become widely available. In the short time since its introduction, MRC has been shown to possess excellent accuracy for the diagnosis of various biliary pathologies, including choledocholithiasis. Investigations of the clinical applications of MRC are ongoing. This review summarizes the diagnostic capabilities of MRC and discusses its application in the management of patients with gallstone diseases.
Collapse
Affiliation(s)
- Terrence H Liu
- Department of Surgery, University of California at San Francisco, UCSF-East Bay, 1411 East 31st Street, Oakland, CA 94602, U.S.A.
| | | |
Collapse
|
42
|
Metcalfe MS, Ong T, Bruening MH, Iswariah H, Wemyss-Holden SA, Maddern GJ. Is laparoscopic intraoperative cholangiogram a matter of routine? Am J Surg 2004; 187:475-81. [PMID: 15041494 DOI: 10.1016/j.amjsurg.2003.12.047] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2003] [Revised: 08/11/2003] [Indexed: 02/08/2023]
Abstract
BACKGROUND Intraoperative cholangiography during laparoscopic cholecystectomy reveals the anatomy of the biliary tree and any stones contained within it. The use of intraoperative cholangiography may be routine for all laparoscopic cholecystectomy. An alternative approach is a selective policy, performing intraoperative cholangiography only for those cases in which choledocholithiasis is suspected on clinical grounds, or those for which the anatomy appears unclear at operation. The literature pertaining to both approaches is reviewed, to delineate their respective merits. METHODS Relevant articles in English were identified from the Medline database, and reviewed. RESULTS The literature reviewed consisted of retrospective analyses. Overall the incidence of unsuspected retained stones was 4%, but only 15% of these would go on to cause clinical problems. The incidence of complete transection of the common bile duct was rare for both routine and selective intraoperative cholangiography policies, and did not differ between them. Rates of minor bile duct injury did not differ between groups, but was more likely to be recognized in the routine group than the selective (P = 0.01). CONCLUSIONS Routine intraoperative cholangiography yields very little useful clinical information over and above that which is obtained with selective policies. Large numbers of unnecessary intraoperative cholangiography are performed under routine intraoperative cholangiography policy, and therefore a selective policy is advocated.
Collapse
Affiliation(s)
- Matthew S Metcalfe
- Department of Surgery, University of Adelaide, The Queen Elizabeth Hospital, Woodville Rd., Woodville, SA 5011, Australia
| | | | | | | | | | | |
Collapse
|
43
|
Gautier G, Pilleul F, Crombe-Ternamian A, Gruner L, Ponchon T, Barth X, Valette PJ. Contribution of magnetic resonance cholangiopancreatography to the management of patients with suspected common bile duct stones. ACTA ACUST UNITED AC 2004; 28:129-34. [PMID: 15060457 DOI: 10.1016/s0399-8320(04)94866-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To evaluate the value of magnetic resonance cholangiography (MRC) as a systematic first-line investigation in the management of patients with suspected common bile duct stones. METHODS Ninety-nine consecutive patients with clinical suspicion of choledocolithiasis were prospectively explored by MRC. All MRCs were interpreted by two radiologists with knowledge of the patient's clinical condition and laboratory results. In case of discrepancy, a third opinion was obtained to reach consensus. The definitive diagnosis was established on the basis of endoscopic exploration of the common bile duct (n=40), clinical and biological follow-up at 6 Months (n=55) or other investigations (n=4). The clinician's level of confidence, management options implemented, and impact of management decisions were used to assess the contribution of MRC. The diagnostic accuracy of MRC for common bile duct stones was also determined. RESULTS At the observed level of confidence (85.9%), MRC identified a differential diagnosis in 7.1% of patients avoiding unnecessary endoscopic exploration in 59.6%. Systematic first-line MRC enabled appropriate management in 83.8% of patients. The sensitivity, specificity, and positive and negative predictive values of MRC for the diagnosis of common bile duct stones were 95.7%, 98.7%, 95.7% and 98.7%, respectively, with excellent inter-observer agreement (kappa=0.915). CONCLUSION Magnetic resonance cholangiography can be used to efficiently screen patients who may need further invasive exploration of the common bile duct. It specifically identifies patients requiring therapeutic ERCP.
Collapse
|
44
|
Abstract
The use of MR imaging in the emergency setting is evolving. Clear indications include situations in need of contrast media when iodinated contrast cannot be administered or to facilitate assessments in pregnant patients and children when exposure to ionizing radiation is considered unacceptable. The availability of rapid, motion-immune sequences now makes MR imaging a feasible study in less cooperative patients extending the range of patients for whom a diagnostic study can be achieved. Capitalizing on the unique benefits of MR imaging there is optimism that MR imaging can eliminate test redundancy and impact patient care in a cost-effective manner. Further investigations are needed to identify the diagnostic algorithms for which this favorable use holds true.
Collapse
Affiliation(s)
- Ivan Pedrosa
- Department of Radiology, Harvard Medical School, Boston, MA, USA.
| | | |
Collapse
|
45
|
Affiliation(s)
- John Baillie
- Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA.
| | | | | |
Collapse
|
46
|
Topal B, Van de Moortel M, Fieuws S, Vanbeckevoort D, Van Steenbergen W, Aerts R, Penninckx F. The value of magnetic resonance cholangiopancreatography in predicting common bile duct stones in patients with gallstone disease. Br J Surg 2003; 90:42-7. [PMID: 12520573 DOI: 10.1002/bjs.4025] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The application of available predictive scoring systems for the detection of common bile duct (CBD) stones has not reduced the number of patients who undergo unnecessary endoscopic retrograde cholangiopancreatography. The aim of this study was to create a predictive model for CBD stones and to assess the value of magnetic resonance cholangiopancreatography (MRCP) in prediction. METHODS In 1998, 366 patients with gallstone disease (118 males, 248 females; mean age 57 (range 8-84) years) underwent cholecystectomy. Statistical analysis was performed on patient data obtained at the time of first presentation. RESULTS CBD stones were demonstrated in 43 (12 per cent) of 366 patients. The predictive model for common duct stones included ultrasonography showing CBD stones or bile duct dilatation, age greater than 60 years, fever, serum alkaline phosphatase level above 670 units/l and serum amylase level above 95 units/l. In patients with a predicted probability greater than 5 per cent, CBD stones were present in 11 per cent, compared with 1 per cent in patients with a probability of 5 per cent or less. MRCP had an observed sensitivity of 95 per cent, specificity of 100 per cent, positive predictive value of 100 per cent and negative predictive value of 98 per cent. CONCLUSION In patients with a predicted probability for CBD stones of more than 5 per cent, MRCP is recommended in order to confirm the presence or absence of stones and as guidance in further management.
Collapse
Affiliation(s)
- B Topal
- Department of Abdominal Surgery, University Hospital Gasthuisberg, Catholic University Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | | | | | | | | | | | | |
Collapse
|
47
|
Bravo FDA, Martí-Bonmatí L, Ruiz A, Jiménez JJ, Isarría S. Colangiografía por RM: estudio funcional con EG-T1 tras Mn-DPDP y comparación con el estudio convencional SS-TSE-T2. RADIOLOGIA 2003. [DOI: 10.1016/s0033-8338(03)77845-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
48
|
Kim JH, Kim MJ, Park SI, Chung JJ, Song SY, Kim KS, Yoo HS, Lee JT, Kim KW. MR cholangiography in symptomatic gallstones: diagnostic accuracy according to clinical risk group. Radiology 2002; 224:410-6. [PMID: 12147836 DOI: 10.1148/radiol.2241011223] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine the diagnostic accuracy of magnetic resonance (MR) cholangiography in the detection of common bile duct (CBD) stones in patients with symptomatic gallstones. MATERIALS AND METHODS Single-shot half-Fourier MR cholangiographic images were obtained in 121 consecutive patients who were referred for MR cholangiography prior to cholecystectomy for symptomatic gallstones. One radiologist interpreted the MR cholangiographic images without prior knowledge of laboratory test results or findings from examinations with other imaging modalities. Patients were retrospectively divided into three groups with high, moderate, and low risk (n = 70, 22, and 29, respectively) for CBD stones. The sensitivity, specificity, and accuracy of MR cholangiography in the detection of CBD stones in each group were calculated. The accuracy of laboratory and sonographic findings in the identification of CBD stones was also calculated. RESULTS CBD stones were diagnosed in 49 (70%) of 70 patients in the high-risk group. One false-positive diagnosis was made, and two false-negative diagnoses were made. Of the 22 patients in the moderate-risk group, seven (32%) had CBD stones, and there was one false-positive and one false-negative diagnosis. In the low-risk group, CBD stones were correctly identified with MR cholangiography in one patient, and there was one false-positive diagnosis. A combination of positive laboratory and sonographic findings yielded a sensitivity of 98% but a specificity of only 34% if any unusual finding in any one of the tests was regarded as a positive finding. CONCLUSION MR cholangiography is highly accurate in the detection of CBD stones in all patients, regardless of the grade of risk, and should be considered in patients with a moderate to high risk of CBD stones before cholecystectomy.
Collapse
Affiliation(s)
- Joo Hee Kim
- Department of Diagnostic Radiology, Yonsei University College of Medicine, Seodaemun-ku Shinchon-dong 134, Seoul 120-752, Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Calvo MM, Bujanda L, Calderón A, Heras I, Cabriada JL, Bernal A, Orive V, Capelastegi A. Role of magnetic resonance cholangiopancreatography in patients with suspected choledocholithiasis. Mayo Clin Proc 2002; 77:422-8. [PMID: 12004991 DOI: 10.4065/77.5.422] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To investigate the diagnostic efficacy of magnetic resonance cholangiopancreatography (MRCP) in choledocholithiasis and to determine whether use of MRCP may eliminate the need for purely diagnostic endoscopic retrograde cholangiopancreatography (ERCP). PATIENTS AND METHODS A total of 116 patients with suspected biliopancreatic pathology were studied prospectively between November 1996 and February 1998. Choledocholithiasis was initially suspected in 61 patients and rated before ERCP and MRCP as being of low, intermediate, or high probability based on clinical, laboratory, and/or imaging findings (Cotton criteria). RESULTS The sensitivity of choledocholithiasis diagnosis was 91%, with a global efficacy of 90%. The level of duct stone obstruction was visualized in all patients. Suprastenotic dilatation also showed a good correlation to ERCP. Choledocholithiasis was found in 32 patients (65%) and 3 patients (33%) in the high- and intermediate-probability groups, respectively. None of the low-probability patients had choledocholithiasis. Endoscopic retrograde cholangiopancreatography was performed for only a diagnostic (not therapeutic) purpose in 3 patients (6%) and 2 patients (22%) of the high- and intermediate-probability cases, respectively. CONCLUSIONS Magnetic resonance cholangiopancreatography seems to be effective in diagnosing choledocholithiasis. It plays a fundamental role in patients with a low or intermediate risk of choledocholithiasis, contributing to the avoidance of purely diagnostic ERCP.
Collapse
Affiliation(s)
- Mari M Calvo
- Department of Gastroenterology, Galdakao Hospital, Spain
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Castellón CJ, Del Amo E, Fernández M. Coledocolitiasis: indicaciones de colangiopancreatografía retrógrada endoscópica y colangiorresonancia magnética. Cir Esp 2002. [DOI: 10.1016/s0009-739x(02)71987-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|