Endoscopic ultrasound versus endoscopic retrograde cholangiography for the diagnosis of choledocholithiasis: the influence of the size of the stone and diameter of the common bile duct (original) (raw)
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Surgery, 1998
In patients with symptomatic cholelithiasis, preoperative diagnosis of common bile duct (CBD) stones can modify the therapeutic strategy. The aims of this prospective, controlled multicenter study were to assess the feasibility, concordance, discordance, and indexes such as sensitivity, specificity, positive and negative predictive values, and accuracy of preoperative endoscopic ultrasonography compared with those of intraoperative cholangiography (IOC) in the diagnosis of asymptomatic CBD stones (i.e., patients undergoing cholecystectomy with no clinical or biologic evidence of CBD stones). From October 1993 to October 1995, 240 consecutive patients with symptomatic cholelithiasis, scheduled for cholecystectomy in 14 surgical centers, were enrolled in this study. All patients were selected for this study according to a preoperative high-risk CBD stone predictive score. Each patient underwent both endoscopic ultrasonography and IOC, as well as surgical exploration of the CBD when stones were detected during one or both preoperative investigations. All patients were seen 1 months and 1 year after operation to check for residual stones. The feasibility of endoscopic ultrasonography was significantly higher overall than that of IOC (99% vs 90%; p < 0.001), except when IOC was through a laparotomy (97% vs 93%; p = 0.16). The number of patients available for study was 215. In 198 cases (92%), results of both investigations were in concordance (161 negative and 37 positive values). Seventeen cases (8%) were discordant. There was overall concordance between the two investigations (kappa coefficient 0.764; 95% confidence interval 0.66 to 0.87), but the percentage of discordance was in favor of IOC. Sensitivity and specificity of IOC were significantly higher than those of endoscopic ultrasonography (1.00 and 0.98 vs 0.85 and 0.93, respectively). With a prevalence of CBD stones of 19%, positive and negative predictive values of IOC were significantly higher than those of endoscopic ultrasonography (0.93 and 1.00 vs 0.75 and 0.96, respectively). Although endoscopic ultrasonography is feasible more often than IOC, IOC is associated with a slightly lower degree of discordance and better information indexes and remains an efficient method of investigation for CBD stones. Endoscopic ultrasonography can be suggested in preference to endoscopic retrograde cholangiography when postoperative residual stones are suspected but need not be performed routinely before cholecystectomy.
International Surgery Journal, 2019
Background: Endoscopic retrograde cholangiopancreatography (ERCP) with consequent laparoscopic cholecystectomy (LC) has been the favored approach for the treatment of choledocholithiasis for a long time; however recently, laparoscopic common bile duct exploration (LCBDE) has been offered to patients with suspected choledocholithiasis. Objective and aim of this work was to compare the efficacy, safety, and the surgical outcomes of LCBDE with ERCP followed by LC and determine the most appropriate approach for patients with choledocholithiasis.Methods: A prospective clinical study was carried out from March 2017 to September 2018. It included 50 patients with cholecysto-choledocholithiasis who were divided into two groups: group A (25 patients) included patients who underwent transcystic LCBDE and stone extraction with LC in one stage, and group B (25 patients) included patients who underwent ERCP followed by LC in two stages. The common bile duct (CBD) stone clearance rate, postoperat...
American Journal of Surgery, 2017
A best evidence topic in surgery was written according to a structured protocol. The question addressed was: in patients with symptomatic gallstones and concomitant common bile duct (CBD) stones, is a single-stage surgical strategy (laparoscopic cholecystectomy (LC) with common bile duct exploration) preferable, or a two-stage procedure involving LC with pre or post-operative endoscopic retrograde cholangiography (ERCP)? Two hundred and six papers were found using the reported search, of which four presented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group, study type, relevant outcomes and results of these papers are tabulated. A recent large meta-analysis concluded no significant difference in the clinical effectiveness or complication rate of either strategy. Three recent smaller studies concurred with this conclusion; however each noted improved cost-effectiveness of the single-stage approach advocating its use as the superior strategy when local resources and expertise are available. We conclude that for patients with symptomatic gallstones and concomitant choledocholithiasis, a single-stage surgical procedure is equivalent to two-stage LC and ERCP in terms of clinical outcomes, is associated with a shorter overall hospital stay and may be more cost-effective. On this basis a singlestage procedure is recommended for management of symptomatic gallstones and choledocholithiasis where local resources and expertise permit.
International Surgery Journal, 2019
Background: Choledocholithiasis implies stones in the common bile duct (CBD). Most of the common bile duct stones are those that have passed into the bile duct from the gall bladder. About 20 to 25% of patients above the age of 60 with symptomatic gall stones are likely to have stones in the CBD. To analyse the role of ERCP and MRCP in the management of choledocholithiasis.Methods: About 60 patients who are attending the General Surgery OPD of Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, Tamil Nadu, India from the October 2017-March 2018 were included in the study with confirmed common bile duct stones with or without gall stones were chosen. patients were categorized into group A- who has undergone a successful ERCP followed by laparoscopic cholecystectomy and group B- who underwent open cholecystectomy with CBD exploration.Results: Ultrasonography was done in 57 patients, of which 41 patients showed CBD stones (71.93%), 12 patients showed dilated CBD ...
British Journal of Surgery, 2002
Background Intraoperative cholangiography and laparoscopic ultrasonography are both used in the detection of common bile duct stones at laparoscopic cholecystectomy. The aim of this prospective study was to determine whether laparoscopic ultrasonography has an alternative or a complementary role with respect to cholangiography in achieving this end. Methods The biliary trees of 900 patients undergoing laparoscopic cholecystectomy were examined routinely by the two methods. The diagnostic power of each investigation and of the two techniques in combination was evaluated. The statistical non-random concordance between the two methods was also determined. Results Laparoscopic ultrasonography was performed in all 900 patients. Cholangiography was performed in 762 (85 per cent). The mean (range) duration was 9·8 (4–21) min for laparoscopic ultrasonography and 17·6 (7–42) min for cholangiography. For the detection of common bile duct stones, with a kappa coefficient of 0·57 (95 per cent c...
World Journal of Laparoscopic Surgery with DVD, 2021
Introduction: Intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) is valuable in the detection of biliary abnormalities. In this study, we aimed to investigate the diagnostic accuracy of IOC during LC for the detection of anatomic variations of the biliary system, as well as the visualization ability of IOC on determining the normal anatomy of the biliary tree. Materials and methods: This cross-sectional study was conducted on patients who were presented to the surgery outpatient clinic and were scheduled for elective LC for symptomatic cholelithiasis. Patients underwent intraoperative laparoscopic ultrasound (LUS) before the dissection of Calot's triangle and IOC video fluoroscopy examination of the extrahepatic biliary tree. Results: Our study enrolled 53 patients. No intraoperative complications occurred in all enrolled patients. LUS was successful in all 53 (100%) cases, while IOC was successful in 50 (94.3%) cases. IOC had accuracy rate of 100% (50 patients) in defining biliary ducts at the porta hepatis compared to 84.91% (45 patients) for LUS with a failure rate of 15.09% (p = 0.60). Concerning stones detection, LUS accuracy indexes were as follows: sensitivity = 80%; specificity = 95.83%; positive predictive value (PPV) = 66.67%; negative predictive value (NPV) = 97.87% 99; and diagnostic odds ratio (DOR) = 92. IOC accuracy indexes were as follows: sensitivity = 80%; specificity = 93.33%; PPV = 57.14%; NPV = 90%; and DOR = 56. Conclusion: The results of the current study encourage using IOC as an effective, accurate, feasible, and safe technique to visualize the biliary tree while performing LC.
Journal of Gastroenterology and Hepatology Research, 2015
AIM: Cost effectively diagnosis of common bile duct stones (CBDS) and timing of management remains a topic of argument for the proper management of such condition. CBD clearance can be done by surgery (open or laparoscopic), endoscopy and lithotripsy. Moreover, the gallbladder which is mostly the source of the stones is indicated for cholecystectomy. This retrospective study is aimed to evaluate the difficulty of laparoscopic cholecystectomy (LC) done after more than 2 weeks period for patients underwent ERC to manage CBDS. METHODS: The present study enrolled 99 (69 males and 30 females) patients, whom suffered from CBD stones. The patients were revised and the clinical records were presented at the National Hepatology and Tropical Medicine Research Institute (NHTMRI)-at surgery department, from May 2012 to November 2014. RESULTS: Preoperative jaundice was positive in 33 patients (total serum bilirubin > 2 mg/dL), ERC was done to all patients and stent was placed in 24 patients. Surgery (LC) was delayed more than 2 weeks due to unfitness for surgery 24, patient reluctance 27, and long waiting list 48 patients. During LC different grades of adhesions at Callot's triangle were reported as; grade I in 27, grade II in 42, grade III in18, and grade IV in 12. Conversion to open surgery occurred in 33 patients. Mortality occurred in 3 patients and morbidity in 30 patients.
British Journal of Surgery, 2016
Background Various minimally invasive approaches exist for the management of choledocholithiasis at the time of laparoscopic cholecystectomy. The aim of this study was to compare endoscopic retrograde cholangiopancreatography (ERCP) with laparoscopic bile duct exploration (LBDE) and test the hypothesis that intraoperative ERCP is no different to LBDE in terms of rate of bile duct clearance or retained stones. Methods Eligible patients with choledocholithiasis undergoing emergency laparoscopic cholecystectomy were randomized to intraoperative ERCP or LBDE in a 1 : 1 ratio. The primary outcomes were rates of bile duct clearance and retained stones. Secondary outcomes were postprocedure complication rate, mortality rate, postoperative length of hospital stay, conversion to open surgery rate, procedural time and total duration of surgery. Results Some 104 patients were randomized, and 52 patients in each group were included in an intention-to-treat analysis. Duct clearance rates were 87...