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Novak A, Acharya A, Beer S, Espinosa A, Smith GB, Saga C, Andrews J, Bailey A, Soonawalla Z, Bungay H, Pavlides M. Pilot feasibility study to determine the utility of direct access and quantitative magnetic resonance cholangiopancreatography (MRCP) in the assessment of suspected acute biliary or ductal gallstone presentations. BMC Gastroenterol 2025; 25:72. [PMID: 39930378 PMCID: PMC11809031 DOI: 10.1186/s12876-025-03637-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Accepted: 01/21/2025] [Indexed: 02/14/2025] Open
Abstract
BACKGROUND Patients with suspected acute gallstone disease typically undergo abdominal ultrasound. MRCP is often used for patients with abnormal LFTs, potentially making ultrasound unnecessary for this group. Despite high inter-reader variability in MRCP interpretation, new AI technologies may automate and standardize detection and measurement. METHOD Patients with suspected acute gallstone disease and abnormal liver function tests were randomized into two diagnostic pathways, direct MRCP and standard care. Admission data, healthcare resource use, and clinical outcomes were recorded. National Health Service national 20/21 tariffs were used to calculate and compare healthcare costs. MRCP scans were subsequently analysed using MRCP + software (Perspectum Ltd). RESULTS 27 participants were enrolled over 12 months, 15 to direct MRCP and 11 to standard care. One patient was excluded from analysis. Mean patient time to diagnostic report and mean per patient associated direct medical cost and mean cost to diagnosis for the direct MRCP and standard of care group was 2.53 days, £449.54, and £647 respectively for the direct MRCP group and 4.18 days costing £742.06 and £896 for standard care. MRCP + analysis of 11 scans showed significant differences between the groups in terms of gallbladder volume (80.2mm3 gallstone present versus 30.1mm3 without, p = 0.018 and cystic duct median width (4.6 mm gallstone present versus 2.7 mm without, p = 0.042). CONCLUSIONS Direct MRCP may be a feasible and potentially cost-effective diagnostic strategy for patients with suspected acute gallstone disease and deranged LFTs. Automated measurement of MRCP parameters shows promise in detecting obstruction. Larger trials are warranted to assess this potential. CLINICAL TRIAL NUMBER This study is registered with ClinicalTrials.gov (NCT03709030). Registration date: October 17, 2018.
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Affiliation(s)
- Alex Novak
- Emergency Medicine Research Oxford (EMROx), Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
- Emergency Department, John Radcliffe Hospital, HeadleyWay, Headington, Oxford, OX39DU, UK.
| | - Anita Acharya
- Oxford University Hospitals NHS Foundation, Oxford, UK
| | - Sally Beer
- Emergency Medicine Research in Oxford, Oxford, UK
| | | | | | - Cyrene Saga
- Oxford University Hospitals NHS Foundation, Oxford, UK
| | - Jane Andrews
- Oxford University Hospitals NHS Foundation, Oxford, UK
| | - Adam Bailey
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Helen Bungay
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Michael Pavlides
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Head of Liver Imaging Research, Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Radcliffe Department of Medicine, University of Oxford, Oxford, UK
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Alshoabi SA, Binnuhaid AA, Muslem HF, Hamid AM, Alhazmi FH, Alrehily FA, Qurashi AA, Abdulaal OM, Alshamrani AF, Omer AM. Demographic Profiles, Etiological Spectrum, and Anatomical Locations of the Post-Hepatic Obstructive Jaundice in Adult Population in Hadhramout Region in Yemen. Diseases 2024; 12:333. [PMID: 39727663 PMCID: PMC11727093 DOI: 10.3390/diseases12120333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2024] [Revised: 12/10/2024] [Accepted: 12/16/2024] [Indexed: 12/28/2024] Open
Abstract
BACKGROUND Obstructive jaundice is a common health challenge in daily clinical practice caused by a heterogeneous group of benign and malignant conditions in or around extrahepatic bile ducts. This study aimed to investigate the causes of obstructive jaundice, analyze the age and sex distribution, and report the locations of obstruction. METHODS This was a retrospective study of electronic records of patients diagnosed with obstructive jaundice in the Hadhramout region in Yemen. RESULTS This study analyzed the data of 303 patients (mean age: 57 ± 17.99 years; range: 18-95 years); 60.40% (n = 183) were female, and 39.60% (n = 120) were male. The highest prevalence was found in middle-aged adults (n = 112, 36.96%), followed by the old (n = 101, 33.33%). Common bile duct (CBD) stones were the most common cause of obstructive jaundice (n = 175, 57.8%), followed by CBD stricture (n = 58, 19.1%), carcinoma of the head of the pancreas (n = 35, 11.6%), cholangiocarcinoma (n = 21, 6.9%), and external compression of the CBD (n = 2, 0.7%). CBD stones, cholangiocarcinoma, and ampulla of Vater masses were more prevalent in females (30.9%, 3.8%, and 2.2%, respectively) than in males (25.8%, 2.9%, and 1.7%, respectively). In contrast, CBD stricture and carcinoma of the pancreas were more frequent in males, occurring in 12.1% and 7.1% of male patients, respectively, compared to 7.9% and 4.9% in female patients. The primary obstruction site was the CBD (n = 254, 83.8%), followed by the head of the pancreas (n = 30, 9.9%), and the ampulla of Vater (n = 13, 4.3%). CONCLUSIONS Obstructive jaundice predominantly affects middle-aged adults followed by the old-aged patients predominantly in females. The most common cause of obstructive jaundice was CBD stones, followed by CBD stricture, while carcinoma of the head of the pancreas was the most common malignant cause, followed by cholangiocarcinoma. Distal CBD is the most common anatomical location of obstructive jaundice.
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Affiliation(s)
- Sultan Abdulwadoud Alshoabi
- Department of Diagnostic Radiology, College of Applied Medical Sciences, Taibah University, Al-Madinah Al-Munawwarah 41477, Saudi Arabia
| | - Abdulkhaleq Ayedh Binnuhaid
- Department of Specialized Surgery, Radiology Section, Faculty of Medicine, Hadhramout University, Hadhramaut, Yemen
| | - Halah Fuad Muslem
- Department of Internal Medicine, Dr. Suliman Al Habib Hospital Altakhasosi, Riyadh 12344, Saudi Arabia
| | | | - Fahad H. Alhazmi
- Department of Diagnostic Radiology, College of Applied Medical Sciences, Taibah University, Al-Madinah Al-Munawwarah 41477, Saudi Arabia
| | - Faisal A. Alrehily
- Department of Diagnostic Radiology, College of Applied Medical Sciences, Taibah University, Al-Madinah Al-Munawwarah 41477, Saudi Arabia
| | - Abdulaziz A. Qurashi
- Department of Diagnostic Radiology, College of Applied Medical Sciences, Taibah University, Al-Madinah Al-Munawwarah 41477, Saudi Arabia
| | - Osamah M. Abdulaal
- Department of Diagnostic Radiology, College of Applied Medical Sciences, Taibah University, Al-Madinah Al-Munawwarah 41477, Saudi Arabia
| | - Abdullah F. Alshamrani
- Department of Diagnostic Radiology, College of Applied Medical Sciences, Taibah University, Al-Madinah Al-Munawwarah 41477, Saudi Arabia
| | - Awatif M. Omer
- Department of Diagnostic Radiology, College of Applied Medical Sciences, Taibah University, Al-Madinah Al-Munawwarah 41477, Saudi Arabia
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Woo JH, Cho H, Ryu K, Choi YW, Lee S, Lee TH, Kim DS, Choi IS, Moon JI, Lee SJ. Predictors of Choledocholithiasis in Cholecystectomy Patients and Their Cutoff Values and Prediction Model in Korea in Comparison with the 2019 ASGE Guidelines. Gut Liver 2024; 18:1060-1068. [PMID: 38712399 PMCID: PMC11565007 DOI: 10.5009/gnl230534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 05/08/2024] Open
Abstract
Background/Aims : In 2019, the American Society for Gastrointestinal Endoscopy (ASGE) established clinical predictors for choledocholithiasis. Our study was designed to evaluate these predictors within the Korean clinical context, establish cutoff values, and develop a predictive model. Methods : This retrospective study analyzed patients who underwent laparoscopic cholecystectomy. The relationships between choledocholithiasis and predictors including age, blood tests, and imaging findings were assessed through univariate and multivariate logistic regression analyses. We established Korean cutoff values for these predictors and developed a scoring system for choledocholithiasis using a multivariate logistic regression. The performance of this scoring system was then compared with that of the 2019 ASGE guidelines through a receiver operating characteristic curve. Results : We established Korean cutoff values for age (>70 years), alanine aminotransferase (>26.5 U/L), aspartate aminotransferase (>28.5 U/L), gamma-glutamyl transferase (GGT; >82.5 U/L), alkaline phosphatase (ALP; >77.5 U/L), and total bilirubin (>0.95 mg/dL). In the multivariate analysis, only age >70 years, GGT >77.5 U/L, ALP >77.5 U/L, and common bile duct dilatation remained significant. We then developed a new Korean risk stratification model from the multivariate analysis, with an area under the curve of 0.777 (95% confidence interval, 0.75 to 0.81). Our model was stratified into the low-risk, intermediate-risk, and high-risk groups with the scores being <1.0, 1.0-5.5, and >5.5, respectively. Conclusions : Predictors of choledocholithiasis in cholecystectomy patients and their cutoff values in Korean should be adjusted and further studies are needed to develop appropriate guidelines.
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Affiliation(s)
- Jung Hun Woo
- Departments of Gastroenterology, Konyang University Myunggok Medical Research Institute, Daejeon, Korea
| | - Hwanhyi Cho
- Departments of Gastroenterology, Konyang University Myunggok Medical Research Institute, Daejeon, Korea
| | - Kihyun Ryu
- Departments of Gastroenterology, Konyang University Myunggok Medical Research Institute, Daejeon, Korea
| | - Young Woo Choi
- Departments of Gastroenterology, Konyang University Myunggok Medical Research Institute, Daejeon, Korea
| | - Sanghyuk Lee
- Departments of Gastroenterology, Konyang University Myunggok Medical Research Institute, Daejeon, Korea
| | - Tae Hee Lee
- Departments of Gastroenterology, Konyang University Myunggok Medical Research Institute, Daejeon, Korea
| | - Dae Sung Kim
- Departments of Gastroenterology, Konyang University Myunggok Medical Research Institute, Daejeon, Korea
| | - In Seok Choi
- Departments of General Surgery, Konyang University Myunggok Medical Research Institute, Daejeon, Korea
| | - Ju Ik Moon
- Departments of General Surgery, Konyang University Myunggok Medical Research Institute, Daejeon, Korea
| | - Seung Jae Lee
- Departments of General Surgery, Konyang University Myunggok Medical Research Institute, Daejeon, Korea
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Zhang D, Dai Z, Sun Y, Sun G, Luo H, Guo X, Gu J, Yang Z. One-Stage Intraoperative ERCP combined with Laparoscopic Cholecystectomy Versus Two-Stage Preoperative ERCP Followed by Laparoscopic Cholecystectomy in the Management of Gallbladder with Common Bile Duct Stones: A Meta-analysis. Adv Ther 2024; 41:3792-3806. [PMID: 39207666 DOI: 10.1007/s12325-024-02949-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 07/16/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION Concomitant gallbladder and common bile duct (CBD) stones, known as cholecystocholedocholithiasis, are clinically prevalent. There is currently no consensus on sequential versus simultaneous management approaches, and, if simultaneous, which approach to adopt. This meta-analysis evaluates the safety and efficacy of one-stage laparoscopic cholecystectomy (LC) with intraoperative endoscopic retrograde cholangiopancreatography (ERCP) versus two-stage ERCP followed by LC for treating concomitant gallbladder and CBD stones. METHODS A comprehensive literature search was conducted in five databases, PubMed, Embase, Web of Science, VIP, and Wanfang, for all randomized controlled trials (RCTs), cohort and retrospective studies published up to February 2024. Data extraction was performed independently by two reviewers. The primary outcomes were CBD stone clearance rate and postoperative complications morbidity. Secondary outcomes included conversion to other procedures and length of hospital stay. Statistical analyses were performed using R (v.4.3.2) with weighted mean differences and odds ratios (ORs) calculated for continuous and dichotomous variables, respectively, with 95% confidence intervals (CIs). RESULTS A total of 17 studies involving 2120 patients have been included, with 898 patients receiving single-stage and 1222 patients undergoing two-stage treatment. Of these studies, 9 were RCTs and 8 were retrospective cohort study. The one-stage group demonstrated superior outcomes in terms of CBD stone clearance (OR = 2.07, p = 0.0004), overall morbidity (OR = 0.35, p < 0.0001), post-operative pancreatitis (OR = 0.49, p = 0.006), conversion to other procedures (OR = 0.38, p = 0.0006), and length of hospital stay (MD = - 2.6456, 95% CI - 3.5776; - 1.7136, p < 0.0001). No significant differences were observed in post-operative cholangitis (OR = 0.44, p = 0.12), post-operative bleeding (OR = 0.76, p = 0.47), or bile leakage (OR = 1.28, p = 0.54). CONCLUSION For patients with concomitant gallbladder and CBD stones, the one-stage approach combining ERCP and LC appears safer and more effective, with advantages including higher stone clearance rates, reduced postoperative complications (particularly pancreatitis), shorter hospital stays, fewer residual stones, and decreased need for additional procedures. However, additional high-quality clinical trials are needed to establish the optimal treatment approach for various patient scenarios.
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Affiliation(s)
- Di Zhang
- Department of Endoscope, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Zihao Dai
- Department of Endoscope, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yong Sun
- Department of Endoscope, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Guoyao Sun
- Department of Endoscope, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Haifeng Luo
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Xiaoyi Guo
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Jiangning Gu
- Department of Endoscope, General Hospital of Northern Theater Command, Shenyang, Liaoning, China.
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
| | - Zhuo Yang
- Department of Endoscope, General Hospital of Northern Theater Command, Shenyang, Liaoning, China.
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V V, S Kumar N, Khan O, Azharuddin SK. Giant Choledocholithiasis With Choledochal Cyst: A Report of a Rare Case. Cureus 2024; 16:e64306. [PMID: 39130959 PMCID: PMC11316851 DOI: 10.7759/cureus.64306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2024] [Indexed: 08/13/2024] Open
Abstract
A giant common bile duct (CBD) calculus is a rare occurrence, and the presence of a giant calculus within a choledochal cyst (CDC) is even more unusual. In this case report, we detail an instance of a giant CBD calculus measuring 7 cm x 3 cm found within a CDC, accompanied by multiple tiny calculi. Magnetic resonance cholangiopancreatography (MRCP) revealed the dilation of the bi-lobar intrahepatic biliary radical (IHBR) and the CBD. A large T2 hypointense and T1 hyperintense calculus occupied the dilated CBD and common hepatic duct (CHD), extending into the left hepatic duct (LHD) and right hepatic duct (RHD). There was a possibility of type 1c CDC with cystolithiasis, hepatolithiasis, and cholelithiasis. The patient underwent open cholecystectomy with choledochotomy, stone retrieval, excision of the CDC, and Roux-en-Y hepaticojejunostomy.
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Affiliation(s)
- Vinay V
- Gastrointestinal Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Nayana S Kumar
- General Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Ozair Khan
- General Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - S K Azharuddin
- Surgical Gastroenterology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
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Mena-Camilo E, Salazar-Colores S, Aceves-Fernández MA, Lozada-Hernández EE, Ramos-Arreguín JM. Non-Invasive Prediction of Choledocholithiasis Using 1D Convolutional Neural Networks and Clinical Data. Diagnostics (Basel) 2024; 14:1278. [PMID: 38928692 PMCID: PMC11202441 DOI: 10.3390/diagnostics14121278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 05/30/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024] Open
Abstract
This paper introduces a novel one-dimensional convolutional neural network that utilizes clinical data to accurately detect choledocholithiasis, where gallstones obstruct the common bile duct. Swift and precise detection of this condition is critical to preventing severe complications, such as biliary colic, jaundice, and pancreatitis. This cutting-edge model was rigorously compared with other machine learning methods commonly used in similar problems, such as logistic regression, linear discriminant analysis, and a state-of-the-art random forest, using a dataset derived from endoscopic retrograde cholangiopancreatography scans performed at Olive View-University of California, Los Angeles Medical Center. The one-dimensional convolutional neural network model demonstrated exceptional performance, achieving 90.77% accuracy and 92.86% specificity, with an area under the curve of 0.9270. While the paper acknowledges potential areas for improvement, it emphasizes the effectiveness of the one-dimensional convolutional neural network architecture. The results suggest that this one-dimensional convolutional neural network approach could serve as a plausible alternative to endoscopic retrograde cholangiopancreatography, considering its disadvantages, such as the need for specialized equipment and skilled personnel and the risk of postoperative complications. The potential of the one-dimensional convolutional neural network model to significantly advance the clinical diagnosis of this gallstone-related condition is notable, offering a less invasive, potentially safer, and more accessible alternative.
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Affiliation(s)
- Enrique Mena-Camilo
- Facultad de Ingeniería, Universidad Autónoma de Querétaro, Querétaro 76010, Mexico; (E.M.-C.); (M.A.A.-F.); (J.M.R.-A.)
| | | | | | | | - Juan Manuel Ramos-Arreguín
- Facultad de Ingeniería, Universidad Autónoma de Querétaro, Querétaro 76010, Mexico; (E.M.-C.); (M.A.A.-F.); (J.M.R.-A.)
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Ahn SH, An C, Kim SS, Park S. CT Evaluation of Long-Term Changes in Common Bile Duct Diameter after Cholecystectomy. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:581-595. [PMID: 38873384 PMCID: PMC11166583 DOI: 10.3348/jksr.2023.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/24/2023] [Accepted: 07/12/2023] [Indexed: 06/15/2024]
Abstract
Purpose The present study aimed to investigate the frequency and extent of compensatory common bile duct (CBD) dilatation after cholecystectomy, assess the time between cholecystectomy and CBD dilatation, and identify potentially useful CT findings suggestive of obstructive CBD dilatation. Materials and Methods This retrospective study included 121 patients without biliary obstruction who underwent multiple CT scans before and after cholecystectomy at a single center between 2009 and 2011. The maximum short-axis diameters of the CBD and intrahepatic duct (IHD) were measured on each CT scan. In addition, the clinical and CT findings of 11 patients who were initially excluded from the study because of CBD stones or periampullary tumors were examined to identify distinguishing features between obstructive and non-obstructive CBD dilatation after cholecystectomy. Results The mean (standard deviation) short-axis maximum CBD diameter of 121 patients was 5.6 (± 1.9) mm in the axial plane before cholecystectomy but increased to 7.9 (± 2.6) mm after cholecystectomy (p < 0.001). Of the 106 patients with a pre-cholecystectomy axial CBD diameter of < 8 mm, 39 (36.8%) showed CBD dilatation of ≥ 8 mm after cholecystectomy. Six of the 17 patients with longterm (> 2 years) serial follow-up CT scans (35.3%) eventually showed a significant (> 1.5-fold) increase in the axial CBD diameter, all within two years after cholecystectomy. Of the 121 patients without obstruction or related symptoms, only one patient (0.1%) showed IHD dilatation > 3 mm after cholecystectomy. In contrast, all 11 patients with CBD obstruction had abdominal pain and abnormal laboratory indices, and 81.8% (9/11) had significant dilatation of the IHD and CBD. Conclusion Compensatory non-obstructive CBD dilatation commonly occurs after cholecystectomy to a similar extent as obstructive dilatation. However, the presence of relevant symptoms, significant IHD dilatation, or further CBD dilatation 2-3 years after cholecystectomy should raise suspicion of CBD obstruction.
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Chen L, Wu Z, Guo C, Wang G, Tu K, Jiang J. Evaluation of Clinical Indications of Three Treatments for Choledocholithiasis with Acute Cholangitis. Int J Gen Med 2023; 16:4669-4680. [PMID: 37868815 PMCID: PMC10588657 DOI: 10.2147/ijgm.s429781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023] Open
Abstract
Objective This study aimed to assess the efficacy of Endoscopic Retrograde Cholangiopancreatography (ERCP), common bile duct exploration, and percutaneous transhepatic cholangiography combined with common bile duct exploration for treating choledocholithiasis with acute cholangitis, to guide management strategies. Methods A retrospective evaluation was conducted on a cohort of 283 inpatients diagnosed with choledocholithiasis and acute cholangitis at the affiliated hospital. Patients were categorized into three groups: Group A (ERCP group), Group B(common bile duct exploration group), and Group C(PTCD combine common bile duct exploration group.) Parameters such as hepatic function recovery, inflammation level control, blood loss, postoperative hospital duration, and postoperative complications were compared. Results All groups exhibited notable reductions in postoperative biochemical parameters including alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), total bilirubin (TBIL), and WBC (P < 0.05). Group A had the least blood loss(P < 0.05), and shortest hospital stay(P < 0.05), but a higher incidence of pancreatitis(P < 0.05), with a total of 8 cases occurred(7.3%). Group C had a shorter hospital stay compared to Group B(P < 0.05). Conclusion For patients with fewer and smaller common bile duct stones and milder symptoms, it is recommended to primarily choose endoscopic retrograde cholangiopancreatography (ERCP), endoscopic sphincterotomy (EST), and endoscopic nasobiliary drainage (ENBD), it procedures offer quicker recovery and cause minimal trauma. For patients with numerous, larger common bile duct stones but stable conditions, bile duct exploration is recommended. For those with severe conditions and significant inflammation, PTCD and common bile duct exploration are advised.
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Affiliation(s)
- Ling Chen
- General Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, 310012, People’s Republic of China
| | - Zujian Wu
- General Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, 310012, People’s Republic of China
| | - Chi Guo
- General Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, 310012, People’s Republic of China
| | - Guoping Wang
- General Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, 310012, People’s Republic of China
| | - Kui Tu
- General Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, 563000, People’s Republic of China
| | - Jichang Jiang
- General Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, 563000, People’s Republic of China
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Ovalle-Chao C, Guajardo-Nieto DA, Elizondo-Pereo RA. Performance of the predictive criteria of the American Society for Gastrointestinal Endoscopy in the diagnosis of choledocholithiasis at a secondary care public hospital in the State of Nuevo León, Mexico. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2023; 88:322-332. [PMID: 35810095 DOI: 10.1016/j.rgmxen.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 11/03/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION AND AIMS Currently there is no ideal diagnostic/therapeutic approach for patients with suspected choledocholithiasis. The primary aim of our study was to evaluate the performance of the criteria for predicting choledocholithiasis proposed by the American Society for Gastrointestinal Endoscopy (ASGE) in 2019. MATERIALS AND METHODS A retrospective study was conducted that included 352 patients seen at a secondary care public healthcare institution in Monterrey, Nuevo León, that treats an open population and does not have endoscopic ultrasound or magnetic resonance cholangiopancreatography at its disposal. RESULTS The most frequent predictor presented by the patients was abnormal liver function tests (90.63%), and with their use alone, sensitivity was higher than that of all the predictors analyzed (91.41%). In addition, the finding of common bile duct stones on ultrasound imaging was the only predictor independently associated with the confirmatory diagnosis of choledocholithiasis. Regarding the general performance of the 2019 criteria, the high-risk category had 68.75% sensitivity, 52.08% specificity, a positive predictive value of 79.28%, a negative predictive value of 38.46%, diagnostic accuracy of 64.20%, and a confirmatory diagnosis of choledocholithiasis in 79.28% of the patients of that risk category. CONCLUSIONS The study corroborated that the presence of choledocholithiasis could be predicted using the choledocholithiasis predictors and risk categories proposed by the ASGE, with acceptable accuracy, in accordance with the standards suggested by those same guidelines.
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Affiliation(s)
- C Ovalle-Chao
- Departamento de Cirugía General, Hospital Metropolitano "Dr. Bernardo Sepúlveda", Monterrey, Nuevo León, Mexico.
| | - D A Guajardo-Nieto
- Departamento de Cirugía General, Hospital Metropolitano "Dr. Bernardo Sepúlveda", Monterrey, Nuevo León, Mexico
| | - R A Elizondo-Pereo
- Departamento de Enseñanza e Investigación en Salud, Christus Muguerza Hospital Alta Especialidad, Monterrey, Nuevo León, Mexico
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Zhang D, Ma Y, Sun W, Wang N, Liu Z, Lu Z. Primary suture for patients of bile duct stones after laparoscopic biliary tract exploration: a retrospective cohort study. Updates Surg 2023; 75:897-903. [PMID: 36749505 DOI: 10.1007/s13304-023-01451-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 02/03/2023] [Indexed: 02/08/2023]
Abstract
There are still many physicians who are reluctant to use primary biliary suture in Laparoscopic common bile duct exploration (LCBDE) for fear of more complications. We compare and analyze the clinical effectiveness of bile duct primary suture with three laparoscopic ports and indwelling T-tube drainage (with four laparoscopic ports) in patients with choledocholithiasis after LCBDE. Clinical data of 135 patients with common bile duct (CBD) stone were compared, including general conditions, postoperative hospital stay, postoperative complications, hospitalization costs, postoperative follow-up and other indicators. Forty-eight patients underwent primary suture of bile duct (group A) and 87 were treated with external T-tube drainage (group B). There were no significant differences between the two groups neither relating to the age, gender, BMI, diameter of CBD, number of stones, preoperative bilirubin value, number of previous surgeries in preoperative, nor the operation time, residual stones, the number of cases converted from laparoscopic conversion to laparotomy. The postoperative complications like fever, bleeding, incision infection, bile duct stricture has no differences between two group. The incidence of bile leakage (p = 0.008) and postoperative electrolyte disturbance (p = 0.001) were slightly lower in group A. There were fewer postoperative complications in group A vs group B (p = 0.04). Patients in group A experienced shorter postoperative hospital stay (p < 0.001), earlier postoperative extubation (p < 0.001), lower total hospitalization costs (p = 0.03), and earlier postoperative recovery (p = 0.000). Primary suture of CBD is a safe and effective method for some patients after LCBDE.
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Affiliation(s)
- DengYong Zhang
- Department of General Surgery, The First Affiliated Hospital of Bengbu Medical College, NO. 287, Changhuai Road, Longzihu District, Bengbu, 233000, Anhui, China
| | - Yang Ma
- Department of General Surgery, The First Affiliated Hospital of Bengbu Medical College, NO. 287, Changhuai Road, Longzihu District, Bengbu, 233000, Anhui, China
| | - Wanliang Sun
- Department of General Surgery, The First Affiliated Hospital of Bengbu Medical College, NO. 287, Changhuai Road, Longzihu District, Bengbu, 233000, Anhui, China
| | - Ning Wang
- Department of Operating Room, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, Anhui, China
| | - Zhong Liu
- Department of General Surgery, The First Affiliated Hospital of Bengbu Medical College, NO. 287, Changhuai Road, Longzihu District, Bengbu, 233000, Anhui, China
| | - Zheng Lu
- Department of General Surgery, The First Affiliated Hospital of Bengbu Medical College, NO. 287, Changhuai Road, Longzihu District, Bengbu, 233000, Anhui, China.
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11
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Evaluation of the Common bile duct (CBD) Diameter After Laparoscopic Cholecystectomy (LC) and Laparoscopic Common Bile Duct Exploration (LCBDE): A Retrospective Study. Surg Laparosc Endosc Percutan Tech 2023; 33:62-68. [PMID: 36630657 PMCID: PMC9889197 DOI: 10.1097/sle.0000000000001135] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/19/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Common Bile duct (CBD) measurement is a crucial aspect in the evaluation of the biliary tree. Whether the CBD undergoes any compensatory change in diameter after laparoscopic cholecystectomy or laparoscopic common bile duct exploration is still up for discussion. The aim of this study was to investigate CBD diameter changes after laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) on magnetic resonance cholangiopancreatography (MRCP). MATERIALS AND METHODS Our retrospective study is divided into 2 sections. The first part assessing CBD diameter changes after laparoscopic cholecystectomy due to gallstones or gallbladder polyps, involved 85 patients, who underwent MRCP procedures. These patients aged between 30 and 85 were divided into an interval LC group (group A, n=56) and a remote LC group (group B, n=29). In group A, the common CBD diameters were measured at their widest portions on MRCP obtained before and after laparoscopic cholecystectomy. Measurements of the CBD diameters were repeated on MRCP obtained twice after the surgery in group B.Section 2 consisted of 38 patients who had choledocholithiasis and were treated with laparoscopic CBD exploration and T-tube placement. These patients aged 26 to 86 formed the interval LCBDE group (group C). The CBD widest diameters were measured on MRCP before LCBDE and after T-tube cholangiography for these individuals.Patients in groups A and C were further divided into 5 and those in group B into 4 age-related subgroups to facilitate statistical analysis. The Pearson correlation test was performed to find any relationship between CBD diameters and age in groups A and B. Paired sample T test was used to compare the significant difference between the 2 sets of CBD diameters in each study group and their subgroups. RESULTS In the interval LC group, the post-LC mean CBD diameter was significantly wider when compared with the preoperative mean diameter ( P <0.05). There was a significant difference between the first and second post-LC means CBD diameter in the remote LC group ( P <0.05). In group C, the mean CBD diameter measured on T-tube cholangiography after LCBDE was significantly smaller than the preoperative dilated mean diameter ( P <0.05). CONCLUSIONS This study demonstrated significant dilation occurring in the common bile duct diameter after laparoscopic cholecystectomy. Furthermore, our remote LC group also supported that claim by showing significant dilation between the first and second post-cholecystectomy CBD diameter values. And lastly, our interval LCBDE sample's initial dilation of the CBD diameters was reduced after surgery and stone extraction.
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12
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Cawich SO, Spence R, Senasi R, Naraynsingh V. Robot-Assisted Common Bile Duct Exploration in Trinidad & Tobago. Cureus 2022; 14:e30965. [PMID: 36465225 PMCID: PMC9711894 DOI: 10.7759/cureus.30965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 11/07/2022] Open
Abstract
Although laparoscopic common bile duct exploration is a feasible and safe option for the operative management of choledocholithiasis, there has been a general reluctance to perform this procedure in Caribbean practice. This is largely because duct exploration is perceived to be difficult with laparoscopic instruments, and endoscopic retrograde cholangiopancreatography (ERCP) has become increasingly available. We report a case in which stones were extracted laparoscopically from the common bile duct, aided by the FreeHand® (Freehand 2010 Ltd., Guildford, Surrey, UK) robot, to show that the procedure is feasible and safe in the Caribbean environment.
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Affiliation(s)
| | - Richard Spence
- Surgery, Port of Spain General Hospital, St Augustine, TTO
| | - Ramdas Senasi
- Radiology, Sunderland NHS Foundation Trust, Sunderland, GBR
| | - Vijay Naraynsingh
- Clinical Surgical Sciences, Port of Spain General Hospital, St. Augustine, TTO
- Surgery, Medical Associates Hospital, St. Joseph, TTO
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13
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Shin J, Oh CH, Dong SH. Single-operator Cholangioscopy Guided Lithotripsy. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2022; 80:163-168. [DOI: 10.4166/kjg.2022.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Jungha Shin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Chi Hyuk Oh
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Seok Ho Dong
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
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Tunruttanakul S, Verasmith K, Patumanond J, Mingmalairak C. Development of a Predictive Model for Common Bile Duct Stones in Patients With Clinical Suspicion of Choledocholithiasis: A Cohort Study. Gastroenterology Res 2022; 15:240-252. [PMID: 36407811 PMCID: PMC9635785 DOI: 10.14740/gr1560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/14/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Current choledocholithiasis guidelines heavily focus on patients with low or no risk, they may be inappropriate for populations with high rates of choledocholithiasis. We aimed to develop a predictive scoring model for choledocholithiasis in patients with relevant clinical manifestations. METHODS A multivariable predictive model development study based on a retrospective cohort of patients with clinical suspicion of choledocholithiasis was used in this study. The setting was a 700-bed public tertiary hospital. Participants were patients who had completed three reference tests (endoscopic retrograde cholangiography, magnetic resonance cholangiopancreatography, and intraoperative cholangiography) from January 2019 to June 2021. The model was developed using logistic regression analysis. Predictor selection was conducted using a backward stepwise approach. Three risk groups were considered. Model performance was evaluated by area under the receiver operating characteristic curve, calibration, classification measures, and decision curve analyses. RESULTS Six hundred twenty-one patients were included; the choledocholithiasis prevalence was 59.9%. The predictors were age > 55 years, pancreatitis, cholangitis, cirrhosis, alkaline phosphatase level of 125 - 250 or > 250 U/L, total bilirubin level > 4 mg/dL, common bile duct size > 6 mm, and common bile duct stone detection. Pancreatitis and cirrhosis each had a negative score. The sum of scores was -4.5 to 28.5. Patients were categorized into three risk groups: low-intermediate (score ≤ 5), intermediate (score 5.5 - 14.5), and high (score ≥ 15). Positive likelihood ratios were 0.16 and 3.47 in the low-intermediate and high-risk groups, respectively. The model had an area under the receiver operating characteristic curve of 0.80 (95% confidence interval: 0.76, 0.83) and was well-calibrated; it exhibited better statistical suitability to the high-prevalence population, compared to current guidelines. CONCLUSIONS Our scoring model had good predictive ability for choledocholithiasis in patients with relevant clinical manifestations. Consideration of other factors is necessary for clinical application, particularly regarding the availability of expert physicians and specialized equipment.
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Affiliation(s)
- Suppadech Tunruttanakul
- Department of Surgery, Sawanpracharak Hospital, Nakhon Sawan 60000, Thailand,Corresponding Author: Suppadech Tunruttanakul, Department of Surgery, Sawanpracharak Hospital, Muang, Nakhon Sawan 60000, Thailand.
| | | | - Jayanton Patumanond
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Chatchai Mingmalairak
- Department of Surgery, Faculty of Medicine, Thammasat University, Pathum Thani 10120, Thailand
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15
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Mínguez A, Ladrón P, Martínez S, Del Val A, Nos P, de-Madaria E. Predictive model of persistent choledocholithiasis in patients with acute biliary pancreatitis. GASTROENTEROLOGÍA Y HEPATOLOGÍA 2022; 46:297-304. [PMID: 36243251 DOI: 10.1016/j.gastrohep.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/06/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Choledocholithiasis causing acute biliary pancreatitis (ABP) may migrate to the duodenum or persist in the common bile duct (CBD). We developed a model for predicting persistent choledocholithiasis (PC) in patients with ABP. METHODS This retrospective cohort study included 204 patients, age ≥18 years (mean age: 73 years, 65.7% women), admitted for ABP in 2013-2018, with at least a magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasonography (EUS), and/or endoscopic retrograde cholangiopancreatography (ERCP). Epidemiological, analytical, imaging, and endoscopic variables were compared between patients with and without PC. Multivariate logistic regression analyses were performed to develop a predictive model of PC. RESULTS Patients underwent MRCP (n=145, 71.1), MRCP and ERCP (n=44, 21.56%), EUS and ERCP (n=1, 0.49%), or ERCP (n=14, 6.86%). PC was detected in 49 patients (24%). PC was strongly associated with CBD dilation, detected in the emergency ultrasound (p<0.001; OR=27; 95% CI: 5.8-185.5), increased blood levels of gamma glutamyl transpeptidase, detected at 72h (p=0.008; OR=3.4; 95% CI: 1.5-8.9); and biliary sludge in the gallbladder (p=0.008; OR=0.03; 95% CI: 0.001-0.3). CONCLUSIONS The predictive model showed a validated area under the curve (AUC) of 0.858 for detecting PC in patients with ABP. A nomogram was developed based on model results. CONCLUSIONS The predictive model was highly effective in detecting PC in patients with ABP. Therefore, this model could be useful in clinical practice.
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16
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Wu X, Wu S, Tang S. Endoscopic nasobiliary drainage-based saline-injection ultrasound: an imaging technique for remnant stone detection after retrograde cholangiopancreatography. BMC Gastroenterol 2022; 22:318. [PMID: 35761194 PMCID: PMC9238265 DOI: 10.1186/s12876-022-02394-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 06/16/2022] [Indexed: 11/19/2022] Open
Abstract
Background The purpose of this retrospective study aimed to assess the accuracy of detection of remnant common bile duct (CBD) stones by injecting saline through endoscopic nasobiliary drainage (ENBD) tubes under transabdominal ultrasound (US) guidance. Method Stone extraction and ENBD are regularly achieved through endoscopic retrograde cholangiopancreatography (ERCP) in patients with CBD stones. At 1–3 days thereafter, routine US studies were performed and repeated, using ENBD tubal saline injections (20–100 mL). Results A total of 302 patients underwent standard ERCP stone extractions in conjunction with occlusion cholangiograms, routine US testing, and ENBD-based saline-injection US exams. By occlusion cholangiogram, remnant stones were suspected in 31 (10.3%) patients in total of 302, and 26 (83.8%) were verified as true positives (sensitivity, 50.9%; specificity, 98.0%). Routine US studies proved suspicious in 13 (4.3%) patients in total of 302, and 12 (92.3%) were verified as true positives (sensitivity, 23.5%; specificity, 99.6%). Using ENBD-based saline-injection US, suspected stones were identified in 50 (16.6%) patients in total of 302, and 46 (92%) were verified as true positives (sensitivity, 90.1%; specificity, 98.4%). The sensitivity of ENBD-based saline-injection US significantly surpassed that of occlusion cholangiogram (p < 0.001) and routine US (p < 0.001). Conclusion Detection of remnant CBD stones via ENBD-based saline-injection US is a valid, inexpensive, and repeatable means of patient screening that is non-invasive, radiation-free, and dynamically informative. This may help improve the accuracy of detecting remnant CBD stones after ERCP. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02394-8.
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17
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Tunruttanakul S, Chareonsil B, Verasmith K, Patumanond J, Mingmalairak C. Evaluation of the American Society of Gastrointestinal Endoscopy 2019 and the European Society of Gastrointestinal Endoscopy guidelines' performances for choledocholithiasis prediction in clinically suspected patients: A retrospective cohort study. JGH Open 2022; 6:434-440. [PMID: 35774349 PMCID: PMC9218518 DOI: 10.1002/jgh3.12773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/06/2022] [Accepted: 05/12/2022] [Indexed: 12/07/2022]
Abstract
Background and Aim The American Society of Gastrointestinal Endoscopy (ASGE) and the European Society of Gastrointestinal Endoscopy (ESGE) have published guidelines for choledocholithiasis. However, the guidelines were formulated using data from a large number of patients with no to low risk of common bile duct (CBD) stones. This study aimed to assess the guidelines' predictive performance in a population with a high frequency of stones. Methods Data for three choledocholithiasis standard reference tests were retrospectively reviewed from January 2019 to June 2021. Clinical parameters were used to categorize patients into risk groups according to the guidelines, and then the guidelines' predictive abilities were calculated. Results Among 1185 patients, 521 were included. The stone prevalence was 61.0% (n = 318). Twelve (2.3%), 146 (28.0%), and 363 (69.7%) patients were classified into low‐, intermediate‐, and high‐risk groups according to the ASGE guidelines, and 30 (5.8%), 149 (28.6%), and 342 (65.6%) according to the ESGE guidelines. Focusing on the high‐risk group, the ASGE guidelines had a positive predictive value of 73.6 and a positive likelihood ratio of 1.78. The ESGE guidelines had a positive predictive value of 73.7 and positive likelihood ratio of 1.79. Both guidelines had equivalent areas under the receiver operating characteristic curve of 0.69 (95% confidence interval [CI]: 0.65–0.73) and 0.68 (95% CI: 0.64–0.72), respectively. Conclusion In the high‐risk group, the guidelines increased the chance of detecting choledocholithiasis by approximately 10% (61.0% prevalence to 73.6 and 73.7% positive predictive value). However, statistically, the guidelines had marginal discriminative performance in a population with high stone prevalence.
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Affiliation(s)
| | | | | | - Jayanton Patumanond
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine Chiang Mai University Chiang Mai Thailand
| | - Chatchai Mingmalairak
- Department of Surgery, Faculty of Medicine Thammasat University Pathum Thani Thailand
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18
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Sagami R, Hayasaka K, Ujihara T, Iwaki T, Katsuyama Y, Harada H, Tsuji H, Sato T, Nishikiori H, Murakami K, Amano Y. Accurate Evaluation of Residual Common Bile Duct Stones by Endoscopic Ultrasound: A Two-Step Check Method for Residual Stone Clearance. Digestion 2022; 103:224-231. [PMID: 35124676 DOI: 10.1159/000521925] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 01/08/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS Residual common bile duct (CBD) stones occasionally become symptomatic after stone removal with endoscopic retrograde cholangiopancreatography (ERCP) upon removal of the endoscopic biliary stent (EBS). An accurate evaluation of residual stones before stent removal is necessary. This study evaluated a new two-step check method using endoscopic ultrasound (EUS) for the detection of residual stones after ERCP stone removal. METHODS Fifty-six patients who underwent CBD stone removal and EBS placement were prospectively enrolled. Residual stones were evaluated by the check method. EBS was removed at the time of the check method or at a later time of residual stone removal. The primary outcome was to evaluate the efficacy of this check method. RESULTS Residual CBD stone/sludge was detected in 20 of 56 patients (35.7%; stones: 28.6%, sludge: 7.1%) by the check method and removed by the ERCP procedure at a later time. After stent and final stone removal, patients were followed for an average of 211 days; cholangitis recurred in only 1.8% of patients. There were no adverse events associated with the check method. Temporary EBS prevented the recurrence of cholangitis by residual stone and caused no adverse events in the pancreatobiliary tract until the two-step check method (median, 113 days; range, 17-232 days). CONCLUSION The new check method may be ideal and feasible for EBS removal because recurrences are very rare when a clear CBD has been verified, and an additional ERCP procedure is also possibly avoided.
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Affiliation(s)
- Ryota Sagami
- Department of Gastroenterology, Oita San-ai Medical Center, Oita, Japan
| | - Kenji Hayasaka
- Department of Gastroenterology, New Tokyo Hospital, Matsudo, Japan
| | - Tetsuro Ujihara
- Department of Gastroenterology, New Tokyo Hospital, Matsudo, Japan
| | - Tomoyuki Iwaki
- Department of Gastroenterology, Urawa Kyosai Hospital, Saitama, Japan
| | - Yasushi Katsuyama
- Department of Gastroenterology, Urawa Kyosai Hospital, Saitama, Japan
| | - Hideaki Harada
- Department of Gastroenterology, Urawa Kyosai Hospital, Saitama, Japan
| | - Hiroaki Tsuji
- Department of Gastroenterology, Oita San-ai Medical Center, Oita, Japan
| | - Takao Sato
- Department of Gastroenterology, Oita San-ai Medical Center, Oita, Japan
| | | | - Kazunari Murakami
- Department of Gastroenterology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Yuji Amano
- Department of Gastroenterology, Urawa Kyosai Hospital, Saitama, Japan
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19
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Dalai C, Azizian JM, Trieu H, Rajan A, Chen FC, Dong T, Beaven SW, Tabibian JH. Machine learning models compared to existing criteria for noninvasive prediction of endoscopic retrograde cholangiopancreatography-confirmed choledocholithiasis. LIVER RESEARCH (BEIJING, CHINA) 2021; 5:224-231. [PMID: 35186364 PMCID: PMC8855981 DOI: 10.1016/j.livres.2021.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/05/2021] [Accepted: 10/20/2021] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND AIMS Noninvasive predictors of choledocholithiasis have generally exhibited marginal performance characteristics. We aimed to identify noninvasive independent predictors of endoscopic retrograde cholangiopancreatography (ERCP)-confirmed choledocholithiasis and accordingly developed predictive machine learning models (MLMs). METHODS Clinical data of consecutive patients undergoing first-ever ERCP for suspected choledocholithiasis from 2015-2019 were abstracted from a prospectively-maintained database. Multiple logistic regression was used to identify predictors of ERCP-confirmed choledocholithiasis. MLMs were then trained to predict ERCP-confirmed choledocholithiasis using pre-ERCP ultrasound (US) imaging only and separately using all available noninvasive imaging (US/CT/magnetic resonance cholangiopancreatography). The diagnostic performance of American Society for Gastrointestinal Endoscopy (ASGE) "high-likelihood" criteria was compared to MLMs. RESULTS We identified 270 patients (mean age 46 years, 62.2% female, 73.7% Hispanic/Latino, 59% with noninvasive imaging positive for choledocholithiasis) with native papilla who underwent ERCP for suspected choledocholithiasis, of whom 230 (85.2%) were found to have ERCP-confirmed choledocholithiasis. Logistic regression identified choledocholithiasis on noninvasive imaging (odds ratio (OR) = 3.045, P = 0.004) and common bile duct (CBD) diameter on noninvasive imaging (OR=1.157, P = 0.011) as predictors of ERCP-confirmed choledocholithiasis. Among the various MLMs trained, the random forest-based MLM performed best; sensitivity was 61.4% and 77.3% and specificity was 100% and 75.0%, using US-only and using all available imaging, respectively. ASGE high-likelihood criteria demonstrated sensitivity of 90.9% and specificity of 25.0%; using cut-points achieving this specificity, MLMs achieved sensitivity up to 97.7%. CONCLUSIONS MLMs using age, sex, race, presence of diabetes, fever, body mass index (BMI), total bilirubin, maximum CBD diameter, and choledocholithiasis on pre-ERCP noninvasive imaging predict ERCP-confirmed choledocholithiasis with good sensitivity and specificity and outperform the ASGE criteria for patients with suspected choledocholithiasis.
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Affiliation(s)
- Camellia Dalai
- UCLA-Olive View Internal Medicine Residency Program, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - John M Azizian
- UCLA-Olive View Internal Medicine Residency Program, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - Harry Trieu
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anand Rajan
- UCLA-Olive View Internal Medicine Residency Program, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - Formosa C Chen
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Tien Dong
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Simon W Beaven
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - James H. Tabibian
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA
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20
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Fratantoni ME, Giuffrida P, Di Menno J, Ardiles V, de Santibañes M, Clariá RS, Palavecino M, de Santibañes E, Pekolj J, Mazza O. Prevalence of Persistent Common Bile Duct Stones in Acute Biliary Pancreatitis Remains Stable Within the First Week of Symptoms. J Gastrointest Surg 2021; 25:3178-3187. [PMID: 34159556 DOI: 10.1007/s11605-021-05068-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/07/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acute biliary pancreatitis (ABP) is often associated with persistent common bile duct (CBD) stones. The best strategy in terms of timing of surgery is still controversial. The aim of the current study is to describe the prevalence of persistent common bile duct (CBD) stones in ABP during the first week of symptoms at a high-volume referral center. STUDY DESIGN Single-institution retrospective analysis of a prospectively collected database. Patients with diagnosis of ABP who underwent laparoscopic cholecystectomy (LC) between January 2009 and December 2019 were extracted. RESULTS Two hundred thirty-one patients were included. Cholecystectomy was performed laparoscopically in 230 (99.57%) patients. Intraoperative cholangiogram was performed in all patients. Two hundred nine (90%) patients had surgery within the first 7 days. Global prevalence of persistent CBD stones during IOC was 19.91% (95% CI 14.96-25.65). No significant association between timing to surgery and presence of CBD stones was found for the first week since the initial attack (p=0.28). Prevalence of CBD stones was significantly higher after day 7 (p=0.007 and 0.005). Positive findings in preoperative MRCP are significantly related to intraoperative CBD stones (p=0.0001). Mild postoperative complications (CD I/II) were present in 21 patients (9.09%). No difference was found in morbidity between CBD stones group and non-CBD stones group (p=0.48). We observed no severe complications nor mortality. CONCLUSIONS In patients with mild acute biliary pancreatitis, the prevalence of persistent CBD stones does not change within the first 7 days since the onset of symptoms. This fact may have major clinical relevance when deciding the optimal therapeutic strategy in this population.
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Affiliation(s)
- Maria Eugenia Fratantoni
- HPB Surgery Section, Department of General Surgery, Hospital Italiano de Buenos Aires, Tte. Gral. Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina.
| | - Pablo Giuffrida
- HPB Surgery Section, Department of General Surgery, Hospital Italiano de Buenos Aires, Tte. Gral. Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina
| | - Juliana Di Menno
- HPB Surgery Section, Department of General Surgery, Hospital Italiano de Buenos Aires, Tte. Gral. Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina
| | - Victoria Ardiles
- HPB Surgery Section and Liver Transplant Unit, General Surgery Service, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina
| | - Martín de Santibañes
- HPB Surgery Section and Liver Transplant Unit, General Surgery Service, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina
| | - Rodrigo Sanchez Clariá
- HPB Surgery Section, Department of General Surgery, Hospital Italiano de Buenos Aires, Tte. Gral. Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina
| | - Martin Palavecino
- HPB Surgery Section, Department of General Surgery, Hospital Italiano de Buenos Aires, Tte. Gral. Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina
| | - Eduardo de Santibañes
- HPB Surgery Section and Liver Transplant Unit, General Surgery Service, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina
| | - Juan Pekolj
- HPB Surgery Section and Liver Transplant Unit, General Surgery Service, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina
| | - Oscar Mazza
- HPB Surgery Section, Department of General Surgery, Hospital Italiano de Buenos Aires, Tte. Gral. Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina
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21
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Metra BM, Guglielmo FF, Halegoua-DeMarzio DL, Civan JM, Mitchell DG. Beyond the Liver Function Tests: A Radiologist's Guide to the Liver Blood Tests. Radiographics 2021; 42:125-142. [PMID: 34797734 DOI: 10.1148/rg.210137] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Liver blood tests (often also known as liver chemistries, liver tests, or the common misnomer liver function tests) are routinely used in diagnosis and management of hepatobiliary disease. Abnormal liver blood test results are often the first indicator of hepatobiliary disease and a common indication for abdominal imaging with US, CT, or MRI. Most of the disease entities can be categorized into hepatocellular or cholestatic patterns, with characteristic traits on liver blood tests. Each pattern has a specific differential, which can help narrow the differential diagnosis when combined with the clinical history and imaging findings. This article reviews the major liver blood tests as well as a general approach to recognizing common patterns of hepatobiliary disease within these tests (hepatocellular, cholestatic, acute liver failure, isolated hyperbilirubinemia). Examples of hepatobiliary disease with hepatocellular or cholestatic patterns are presented with characteristic test abnormalities and imaging findings. The commonly encountered scenario of chronic hepatitis with possible fibrosis is also reviewed, with discussion of potential further imaging such as elastography. The role of liver blood tests and imaging in evaluating complications of hepatic transplant is also discussed. Overall, integrating liver blood test patterns with imaging findings can help the radiologist accurately diagnose hepatobiliary disease, especially in cases where imaging findings may not allow differentiation between different entities. ©RSNA, 2021.
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Affiliation(s)
- Brandon M Metra
- From the Departments of Radiology (B.M.M., F.F.G., D.G.M.) and Internal Medicine (D.L.H.D., J.M.C.), Division of Gastroenterology and Hepatology, Thomas Jefferson University, 132 S 10th St, Main Bldg, Philadelphia, PA 19107
| | - Flavius F Guglielmo
- From the Departments of Radiology (B.M.M., F.F.G., D.G.M.) and Internal Medicine (D.L.H.D., J.M.C.), Division of Gastroenterology and Hepatology, Thomas Jefferson University, 132 S 10th St, Main Bldg, Philadelphia, PA 19107
| | - Dina L Halegoua-DeMarzio
- From the Departments of Radiology (B.M.M., F.F.G., D.G.M.) and Internal Medicine (D.L.H.D., J.M.C.), Division of Gastroenterology and Hepatology, Thomas Jefferson University, 132 S 10th St, Main Bldg, Philadelphia, PA 19107
| | - Jesse M Civan
- From the Departments of Radiology (B.M.M., F.F.G., D.G.M.) and Internal Medicine (D.L.H.D., J.M.C.), Division of Gastroenterology and Hepatology, Thomas Jefferson University, 132 S 10th St, Main Bldg, Philadelphia, PA 19107
| | - Donald G Mitchell
- From the Departments of Radiology (B.M.M., F.F.G., D.G.M.) and Internal Medicine (D.L.H.D., J.M.C.), Division of Gastroenterology and Hepatology, Thomas Jefferson University, 132 S 10th St, Main Bldg, Philadelphia, PA 19107
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22
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Pareek T, R R, R P, Chidambaranathan S, O L NB. A Single Centre Experience With Routine Magnetic Resonance Cholangiopancreatography in the Management of Patients With Gall Stone Disease. Cureus 2021; 13:e18743. [PMID: 34790490 PMCID: PMC8588194 DOI: 10.7759/cureus.18743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 11/05/2022] Open
Abstract
AIM To evaluate the role of preoperative magnetic resonance cholangiopancreatography (MRCP) in detection of common bile duct stone (CBDS) in cases of gall stone disease (GSD). METHODS This is a retrospective study with a prospectively maintained database, carried out in 116 patients who underwent laparoscopic cholecystectomy (LC) for GSD, from October 2017 to September 2020. Preoperative MRCP was performed in all cases. RESULTS MRCP detected CBDS in 23 out of 116 patients (19.8%) including silent CBDS in seven patients (6%). In situations of normal biochemical parameters and USG abdomen, 30.4% unnoticed CBDS out of all 23 CBDS, were discovered by MRCP. The sensitivity and specificity of aspartate aminotransferase (AST) or alanine aminotransferase (ALT) [positive predictive value (PPV): 24%; negative predictive value (NPV): 81.3%], alkaline phosphatase (ALP) (PPV: 63.2%; NPV: 88.7%), serum total bilirubin (PPV: 57.1%; NPV: 88.4%) and CBD diameter (PPV: 61.5%; NPV: 85.4%) were, respectively, 26.1% and 79.6%, 52.2% and 92.5%, 52.2% and 90.3%, and 34.8% and 94.6%. Cystic duct variations found in nine patients (7.75%). There was no bile duct injury (0%) noted in post operative patients. CONCLUSION With normal biochemical and USG parameters, MRCP is a valuable non-invasive investigation to detect the overlooked CBDS. After recognising the cystic duct variants, it may be possible to prevent bile duct injury. Before performing a laparoscopic cholecystectomy (LC) in GSD, a routine preoperative MRCP is highly recommended.
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Affiliation(s)
- Tanmay Pareek
- Surgical Gastroenterology, Madras Medical College, Chennai, IND
| | - Rajkumar R
- Surgical Gastroenterology, Madras Medical College, Chennai, IND
| | - Prabhakaran R
- Surgical Gastroenterology, Madras Medical College, Chennai, IND
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Ding S, Dong S, Zhu H, Wu W, Hu Y, Li Q, Zheng S. Factors related to the spontaneous passage of common bile duct stones through the papilla: a single-center retrospective cohort study. J Int Med Res 2021; 49:3000605211058381. [PMID: 34787001 PMCID: PMC8607487 DOI: 10.1177/03000605211058381] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/14/2021] [Indexed: 12/07/2022] Open
Abstract
OBJECTIVE Common bile duct (CBD) stones can spontaneously pass through the papilla. This study explored factors associated with stone passage by comparing differences in the clinical features of stones retained in the CBD and excreted stones. METHODS Data were retrospectively collected for all patients who were hospitalized in our center between March 2016 and May 2021 with clinical, laboratory, or imaging evidence of CBD stones. All patients underwent endoscopic retrograde cholangiopancreatography (ERCP) and were classified into two groups: group A (stones extracted by ERCP, n = 86) and group B (stones discharged before ERCP, n = 15). Demographic data, biochemical and radiological findings were compared between the groups. RESULTS Stone size (0.82 vs. 0.33 cm), and levels of total bilirubin (58.2 vs. 28.8 μmol/L), gamma-glutamyl transpeptidase (416.7 vs. 193.9 U/L), alkaline phosphatase (191.9 vs. 123.1 U/L), carbohydrate antigen 19-9 (603.7 vs. 37.2 U/mL), and α-L-fucosidase (37.4 vs. 22.6 U/L) were significantly higher in group A than in group B. Logistic regression analyses showed that stone size was the only factor significantly associated with spontaneous passage of CBD stones. CONCLUSIONS CBD stones less than 0.33 cm in size may be self-expelled through the papilla.
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Affiliation(s)
- Songming Ding
- Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren
University, Zhejiang Shuren
University, Shulan International Medical College, Hangzhou, Zhejiang,
P.R. China
| | - Shanjie Dong
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R.
China
| | - Hengkai Zhu
- Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren
University, Zhejiang Shuren
University, Shulan International Medical College, Hangzhou, Zhejiang,
P.R. China
| | - Weilin Wu
- Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren
University, Zhejiang Shuren
University, Shulan International Medical College, Hangzhou, Zhejiang,
P.R. China
| | - Yiting Hu
- Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren
University, Zhejiang Shuren
University, Shulan International Medical College, Hangzhou, Zhejiang,
P.R. China
| | - Qiyong Li
- Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren
University, Zhejiang Shuren
University, Shulan International Medical College, Hangzhou, Zhejiang,
P.R. China
| | - Shusen Zheng
- Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren
University, Zhejiang Shuren
University, Shulan International Medical College, Hangzhou, Zhejiang,
P.R. China
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R.
China
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Govindan S, Tamrat NE, Liu ZJ. Effect of Ageing on the Common Bile Duct Diameter. Dig Surg 2021; 38:368-376. [PMID: 34673652 DOI: 10.1159/000519446] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 09/02/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The aim of the study was to determine if the common bile duct (CBD) diameter increases physiologically with age and investigate whether gallstones lead to changes in CBD diameter. METHOD Our study is composed of 721 patients in 2 groups: 517 asymptomatic patients and 204 gallstones patients who underwent MRCP. Their CBD diameter was measured at its widest visible portion on MRCP. Simple linear regression of the average of these measurements was used to investigate the relationship between age and CBD diameter in both populations. Subjects were further divided into 8 subgroups age-wise, respectively, and their means compared decade-wise using ANOVA. Furthermore, each subgroup mean from both populations was compared with each other using a t test. RESULTS Among the 517 subjects, the mean CBD diameter was 5.3663 mm ± 1.43546 and correlated with age (p < 0.01), dilating at 0.07 mm/year. The mean diameter of our oldest group was 7.9 mm, resulting in a plausible upper limit of 8 mm for the asymptomatic population. The mean CBD diameter of the cholelithiasis population was 5.6738 mm ± 1.40986 and also correlated with age (p < 0.01). The mean CBD diameter of the age groups from the cholelithiasis population was larger than that from the asymptomatic population, but none were statistically significant. CONCLUSION Although the CBD increases physiologically with age, there is no significant difference in CBD size between the general population and the cholelithiasis patients at any particular age. Gallstones do not independently dilate the CBD.
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Affiliation(s)
- Shankara Govindan
- Department of General Surgery, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing, China,
| | - Nebiyu Elias Tamrat
- Department of Urology, Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zi Jun Liu
- Department of General Surgery, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing, China
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Cianci P, Restini E. Management of cholelithiasis with choledocholithiasis: Endoscopic and surgical approaches. World J Gastroenterol 2021; 27:4536-4554. [PMID: 34366622 PMCID: PMC8326257 DOI: 10.3748/wjg.v27.i28.4536] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/02/2021] [Accepted: 06/25/2021] [Indexed: 02/06/2023] Open
Abstract
Gallstone disease and complications from gallstones are a common clinical problem. The clinical presentation ranges between being asymptomatic and recurrent attacks of biliary pain requiring elective or emergency treatment. Bile duct stones are a frequent condition associated with cholelithiasis. Amidst the total cholecystectomies performed every year for cholelithiasis, the presence of bile duct stones is 5%-15%; another small percentage of these will develop common bile duct stones after intervention. To avoid serious complications that can occur in choledocholithiasis, these stones should be removed. Unfortunately, there is no consensus on the ideal management strategy to perform such. For a long time, a direct open surgical approach to the bile duct was the only unique approach. With the advent of advanced endoscopic, radiologic, and minimally invasive surgical techniques, however, therapeutic choices have increased in number, and the management of this pathological situation has become multidisciplinary. To date, there is agreement on preoperative management and the need to treat cholelithiasis with choledocholithiasis, but a debate still exists on how to cure the two diseases at the same time. In the era of laparoscopy and mini-invasiveness, we can say that therapeutic approaches can be performed in two sessions or in one session. Comparison of these two approaches showed equivalent success rates, postoperative morbidity, stone clearance, mortality, conversion to other procedures, total surgery time, and failure rate, but the one-session treatment is characterized by a shorter hospital stay, and more cost benefits. The aim of this review article is to provide the reader with a general summary of gallbladder stone disease in association with the presence of common bile duct stones by discussing their epidemiology, clinical and diagnostic aspects, and possible treatments and their advantages and limitations.
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Affiliation(s)
- Pasquale Cianci
- Department of Surgery and Traumatology, Hospital Lorenzo Bonomo, Andria 76123, Italy
| | - Enrico Restini
- Department of Surgery and Traumatology, Hospital Lorenzo Bonomo, Andria 76123, Italy
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Lesmana CRA, Paramitha MS, Lesmana LA. Innovation of endoscopic management in difficult common bile duct stone in the era of laparoscopic surgery. World J Gastrointest Endosc 2021; 13:198-209. [PMID: 34326941 PMCID: PMC8311469 DOI: 10.4253/wjge.v13.i7.198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/18/2021] [Accepted: 07/06/2021] [Indexed: 02/06/2023] Open
Abstract
Common bile duct (CBD) stone is a common biliary problem, which often requires endoscopic approach as the initial treatment option. Roughly, 7%-12% of the subjects who experience cholecystectomy were subsequently referred to biliary endoscopist for further management. In general, there are three classifications of difficult CBD stone, which are based on the characteristics of the stone (larger than 15 mm, barrel or square-shaped stones, and hard consistency), accessibility to papilla related to anatomical variations, and other clinical conditions or comorbidities of the patients. Currently, endoscopic papillary large balloon dilation (EPLBD) of a previous sphincterotomy and EPLBD combined with limited sphincterotomy performed on the same session is still recommended by the European Society of Gastrointestinal Endoscopy as the main approach in difficult CBD stones with history of failed sphincterotomy and balloon and/or basket attempts. If failed extraction is still encountered, mechanical lithotripsy or cholangioscopy-assisted lithotripsy or extracorporeal shockwave lithotripsy can be considered. Surgical approach can be considered when stone extraction is still failed or the facilities to perform lithotripsy are not available. To our knowledge, conflicting evidence are still found from previous studies related to the comparison between endoscopic and surgical approaches. The availability of experienced operator and resources needs to be considered in creating individualized treatment strategies for managing difficult biliary stones.
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Affiliation(s)
- Cosmas Rinaldi Adithya Lesmana
- Department of Internal Medicine, Hepatobiliary Division, Dr. Cipto Mangunkusumo National General Hospital, Universitas Indonesia, Jakarta 10430, DKI, Indonesia
- Digestive Disease and GI Oncology Center, Medistra Hospital, Jakarta 12950, DKI, Indonesia
| | - Maria Satya Paramitha
- Department of Internal Medicine, Hepatobiliary Division, Dr. Cipto Mangunkusumo National General Hospital, Universitas Indonesia, Jakarta 10430, DKI, Indonesia
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27
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Yahya S, Alabousi A, Abdullah P, Ramonas M. The Diagnostic Yield of Magnetic Resonance Cholangiopancreatography in the Setting of Acute Pancreaticobiliary Disease - A Single Center Experience. Can Assoc Radiol J 2021; 73:75-83. [PMID: 34024155 DOI: 10.1177/08465371211013786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To discern whether preceding ultrasound (US) results, patient demographics and biochemical markers can be implemented as predictors of an abnormal Magnetic Resonance Cholangiopancreatography (MRCP) study in the context of acute pancreaticobiliary disease. METHODS A retrospective study was performed assessing US results, age, gender, elevated lipase and biliary enzymes for consecutive patients who underwent an urgent MRCP following an initial US for acute pancreaticobiliary disease between January 2017-December 2018. Multivariable binary logistic regression models were constructed to assess for predictors of clinically significant MRCPs, and discrepant US/MRCP results. RESULTS A total of 155 patients (mean age 56, 111 females) were included. Age (OR 1.03, P < 0.05), hyperlipasemia (OR 5.33, P < 0.05) and a positive US (OR 40.75, P < 0.05) were found to be independent predictors for a subsequent abnormal MRCP. Contrarily, gender and elevated biliary enzymes were not reliable predictors of an abnormal MRCP, or significant MRCP/US discrepancies. Of 66 cases (43%) of discordant US/MRCPs, half had clinically significant discrepant findings such as newly discovered choledocholithiasis and pancreaticobiliary neoplasia. Age was the sole predictor for a significant US/MRCP discrepancy, with 2% increase in the odds of a significant discrepancy per year of increase in age. CONCLUSION An abnormal US, hyperlipasemia and increased age serve as predictors for a subsequent abnormal MRCP, as opposed to gender and biliary enzyme elevation. Age was the sole predictor of a significant US/MRCP discrepancy that provided new information which significantly impacted subsequent management. In the remaining cases, however, MRCP proved useful in reaffirming the clinical diagnosis and avoiding further investigations.
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Affiliation(s)
- Sultan Yahya
- Department of Radiology, 3710McMaster University, Hamilton, Ontario, Canada.,Department of Radiology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Alabousi
- Department of Radiology, 3710McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Peri Abdullah
- School of Kinesiology and Health Science, 7991York University, Toronto, Ontario, Canada
| | - Milita Ramonas
- Department of Radiology, 3710McMaster University, Juravinski Hospital, Hamilton, Ontario, Canada
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28
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GELDIGITTI IT, KARAHAN SR, ADAS G, KOC B, GURBUZ E, OZSOY A. Treatment of common bile duct stones following failed endoscopic retrograde cholangiopancreatography. Chirurgia (Bucur) 2021. [DOI: 10.23736/s0394-9508.20.05122-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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29
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Oh CH, Dong SH. Recent advances in the management of difficult bile-duct stones: a focus on single-operator cholangioscopy-guided lithotripsy. Korean J Intern Med 2021; 36:235-246. [PMID: 32972127 PMCID: PMC7969058 DOI: 10.3904/kjim.2020.425] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/14/2020] [Indexed: 12/16/2022] Open
Abstract
The most effective and the standard treatment for bile duct stones (BDSs) is endoscopic retrograde cholangiopancreatography (ERCP). However, in 10% to 15% of patients with BDSs, the stones cannot be removed by conventional ERCP, which involves endoscopic sphincterotomy followed by balloon or basket extraction. Additional techniques or devices are often necessary to remove these difficult bileduct stones, including endoscopic papillary large balloon dilatation to make a larger papillary opening and/or mechanical lithotripsy to fragment the stones. Advances in cholangioscopy have made possible electrohydraulic or laser lithotripsy under direct cholangioscopic visualization during ERCP. Cholangioscopy-guided lithotripsy could be another good option in the armamentarium of techniques for removing difficult BDSs. Here we review endoscopic techniques based on single-operator cholangioscopy for the management of difficult BDSs.
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Affiliation(s)
- Chi Hyuk Oh
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Seok Ho Dong
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea
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30
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Trout AT, Anupindi SA, Freeman AJ, Macias-Flores JA, Martinez JA, Parashette KR, Shah U, Squires JH, Morinville VD, Husain SZ, Abu-El-Haija M. North American Society for Pediatric Gastroenterology, Hepatology and Nutrition and the Society for Pediatric Radiology Joint Position Paper on Noninvasive Imaging of Pediatric Pancreatitis: Literature Summary and Recommendations. J Pediatr Gastroenterol Nutr 2021; 72:151-167. [PMID: 33003171 DOI: 10.1097/mpg.0000000000002964] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
ABSTRACT The reported incidence of pediatric pancreatitis is increasing. Noninvasive imaging, including ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), play important roles in the diagnosis, staging, follow-up, and management of pancreatitis in children. In this position paper, generated by members of the Pancreas Committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) and the Abdominal Imaging Committee of The Society for Pediatric Radiology (SPR), we review the roles of noninvasive imaging in pediatric acute, acute recurrent, and chronic pancreatitis. We discuss available evidence related to noninvasive imaging, highlighting evidence specific to pediatric populations, and we make joint recommendations for use of noninvasive imaging. Further, we highlight the need for research to define the performance and role of noninvasive imaging in pediatric pancreatitis.
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Affiliation(s)
- Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center
- Department of Radiology
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Sudha A Anupindi
- Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - A Jay Freeman
- Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, Atlanta, GA
| | | | - J Andres Martinez
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN
| | - Kalyan R Parashette
- Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA
| | - Uzma Shah
- Pediatric Gastroenterology, Hepatology and Nutrition, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA
| | - Judy H Squires
- Department of Radiology, University of Pittsburgh Medical Center, Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Veronique D Morinville
- Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Sohail Z Husain
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Stanford School of Medicine, Stanford, CA
| | - Maisam Abu-El-Haija
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
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Hormati A, Ghadir MR, Sarkeshikian SS, Alemi F, Moghaddam M, Ahmadpour S, Mohammadbeigi A, Sivandzadeh GR. Adding ursodeoxycholic acid to the endoscopic treatment and common bile duct stenting for large and multiple biliary stones: Will it improve the outcomes? BMC Gastroenterol 2020; 20:374. [PMID: 33172395 PMCID: PMC7653844 DOI: 10.1186/s12876-020-01523-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/02/2020] [Indexed: 02/06/2023] Open
Abstract
Background The role of common bile duct (CBD) stenting in the establishment of bile stream in the elderly patients and the ones who are not good candidates for surgery due to not responding to treatments was well documented in previous studies. The current study aimed at investigating the effect of adding Ursodeoxycholic acid (UDCA) to CBD stenting alone in order to reduce the size of large and multiple CBD stones.
Methods Clinical outcomes including success rates in CBD stones clearance, incidence of pancreatitis, perforation, bleeding, as well as, decrease in size of stones and liver enzymes after a two-month period were assessed in the UDCA + CBD stenting group. Results A total of 64 patients referring to Shahid Beheshti Hospital in Qom, Iran with multiple or large CBD stones (above three or larger than 15 mm) received standard endoscopic therapies and UDCA + CBD stenting (group B) and controls only received standard endoscopic therapies with only CBD stenting (group A). The mean reduction in the size of stones in group B was significantly higher than that of group A (3.22 ± 1.31 vs 4.09 ± 1.87 mm) (p = 0.034). There was no difference in the incidence rate of complications including pancreatitis, cholangitis, bleeding, and perforation between the two groups (P > 0.05). Conclusion Adding UDCA to CBD stenting, due to decrease in the stone size and subsequently facilitation of the stones outlet, can be considered as the first-line treatment for patients with large and multiple CBD stones. Also, in the cases with large or multi stones may be effective in reducing size and subsequently stone retrieval. Trial registry The study protocol was approved by the Ethics Committee of Qom University of Medical Sciences (ethical code: IR.MUQ.REC.1397.075); the study was also registered in the Iranian Registry of Clinical Trials (No. IRCT20161205031252N8). This study adheres to CONSORT guidelines.
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Affiliation(s)
- Ahmad Hormati
- Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran.,Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Ghadir
- Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Seyed Saeed Sarkeshikian
- Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Faezeh Alemi
- Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran.
| | - Majid Moghaddam
- Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Sajjad Ahmadpour
- Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Abolfazl Mohammadbeigi
- Research Center for Environmental Pollutants, Qom University of Medical Sciences, Qom, Iran
| | - Gholam Reza Sivandzadeh
- Department of Internal Medicine, Gatroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Lem S, Wang S, Tsai C, Sun M. The efficacy and accuracy of endoscopic ultrasound for detecting common bile duct stones in intermediate to high‐risk patients with non‐diagnostic
CT
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MRCP. ADVANCES IN DIGESTIVE MEDICINE 2020. [DOI: 10.1002/aid2.13232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Seng‐Gaip Lem
- Division of Hepatobiliary and Gastroenterology Department of Internal Medicine, Yuan's General Hospital, Kaohsiung Taiwan
| | - Szu‐Jen Wang
- Division of Hepatobiliary and Gastroenterology Department of Internal Medicine, Yuan's General Hospital, Kaohsiung Taiwan
| | - Ching‐Yang Tsai
- Division of Hepatobiliary and Gastroenterology Department of Internal Medicine, Yuan's General Hospital, Kaohsiung Taiwan
| | - Meng‐Shun Sun
- Division of Hepatobiliary and Gastroenterology Department of Internal Medicine, Yuan's General Hospital, Kaohsiung Taiwan
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33
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MUHAMMEDOĞLU B, PİRCANOĞLU E, TORUN S. Choledocholithiasis without cholecystolithiasis, after endoscopic retrograde cholangiopancreatography follow-up without cholecystectomy. KONURALP TIP DERGISI 2020. [DOI: 10.18521/ktd.714664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Oral Bile Reinfusion in Chronic Percutaneous Transhepatic Cholangiodrainage. ACG Case Rep J 2020; 7:e00421. [PMID: 32766363 PMCID: PMC7373573 DOI: 10.14309/crj.0000000000000421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/08/2020] [Indexed: 11/17/2022] Open
Abstract
Percutaneous transhepatic cholangiodrainage is an intervention for obstructive jaundice that, although effective in decreasing bilirubin levels, often leads to depletion of regular bile acids that subsequently cause malabsorption, diarrhea, and acute kidney injury. Bile reinfusion (BR) is a method of enteral refeeding of biliary secretions to replenish innate bile acids to the patient. In addition, BR is a low-cost alternative to exogenous bile acid replacement and abates the need for inpatient fluid resuscitation. We report oral BR in a patient with percutaneous transhepatic cholangiodrainage due to choledocholithiasis and review the literature on BR.
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Khoury T, Kadah A, Mahamid M, Mari A, Sbeit W. Bedside score predicting retained common bile duct stone in acute biliary pancreatitis. World J Clin Cases 2020; 8:1414-1423. [PMID: 32368534 PMCID: PMC7190963 DOI: 10.12998/wjcc.v8.i8.1414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 03/03/2020] [Accepted: 04/15/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Retained common bile duct (CBD) stone after an acute episode of biliary pancreatitis is of paramount importance since stone extraction is mandatory. AIM To generate a simple non-invasive score to predict the presence of CBD stone in patients with biliary pancreatitis. METHODS We performed a retrospective study including patients with a diagnosis of biliary pancreatitis. One hundred and fifty-four patients were included. Thirty-three patients (21.5%) were diagnosed with CBD stone by endoscopic ultrasound (US). RESULTS In univariate analysis, age (OR: 1.048, P = 0.0004), aspartate transaminase (OR: 1.002, P = 0.0015), alkaline phosphatase (OR: 1.005, P = 0.0005), gamma-glutamyl transferase (OR: 1.003, P = 0.0002) and CBD width by US (OR: 1.187, P = 0.0445) were associated with CBD stone. In multivariate analysis, three parameters were identified to predict CBD stone; age (OR: 1.062, P = 0.0005), gamma-glutamyl transferase level (OR: 1.003, P = 0.0003) and dilated CBD (OR: 3.685, P = 0.027), with area under the curve of 0.8433. We developed a diagnostic score that included the three significant parameters on multivariate analysis, with assignment of weights for each variable according to the co-efficient estimate. A score that ranges from 51.28 to 73.7 has a very high specificity (90%-100%) for CBD stones, while a low score that ranges from 9.16 to 41.04 has a high sensitivity (82%-100%). By performing internal validation, the negative predictive value of the low score group was 93%. CONCLUSION We recommend incorporating this score as an aid for stratifying patients with acute biliary pancreatitis into low or high probability for the presence of CBD stone.
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Affiliation(s)
- Tawfik Khoury
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
- Department of Gastroenterology, Galilee Medical Center, Nahariya 22100, Israel
- Gastroenterology and endoscopy units, The Nazareth Hospital EMMS, Nazareth 16100, Israel
| | - Anas Kadah
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
- Department of Gastroenterology, Galilee Medical Center, Nahariya 22100, Israel
| | - Mahmud Mahamid
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
- Gastroenterology and endoscopy units, The Nazareth Hospital EMMS, Nazareth 16100, Israel
| | - Amir Mari
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
- Gastroenterology and endoscopy units, The Nazareth Hospital EMMS, Nazareth 16100, Israel
| | - Wisam Sbeit
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
- Department of Gastroenterology, Galilee Medical Center, Nahariya 22100, Israel
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Asare O, Osei F, Appau AY, Sarkodie B, Tachi K, Nkansah A, Acheampong T, Nwaokweanwe C, Olayiwola D. Aetiology of Obstructive Jaundice in Ghana: A Retrospective Analysis in a Tertiary Hospital. JOURNAL OF WEST AFRICAN COLLEGE OF SURGEONS 2020; 10:36-39. [PMID: 35720953 PMCID: PMC9202603 DOI: 10.4103/jwas.jwas_46_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/15/2022] [Indexed: 11/04/2022]
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Hormati A, Ghadir MR, Hasanpour Dehkordi A, Yadollahi F, Salehitali S, Afifian M. Consequences of Stenting and Endoscopic Papillary Balloon Dilatation in Treatment of Large and Multiple Common Bile Duct Stones. Middle East J Dig Dis 2019; 11:205-210. [PMID: 31824623 PMCID: PMC6895848 DOI: 10.15171/mejdd.2019.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/01/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Although stenting for the treatment of large and multiple common bile duct stones has been acceptable to everyone, its efficacy and outcome have not been studied in comparison with other endoscopic procedures. The purpose of this study was to compare the consequences of stenting and endoscopic papilla balloon dilatation for the treatment of large and multiple common bile duct stones. METHODS In a double-blind clinical trial, of 431 patients with bile duct stones referred to the treatment center, 64 patients with multiple common bile duct stones ( ≥ 3) and more than 15 cm were selected for the study, then by random allocation rule the participants were allocated in two groups. They were entered into two different endoscopic papillary balloon dilatation (EPBD) and common bile ducts stenting treatments so that both procedures were performed by a person. Both groups were assessed from the point of views therapeutic outcomes such as duct cleaning, pancreatitis, isolated pain, and duct rupture. Data were collected by a self-made questionnaire that was used before and after the procedure to obtain the needed information. Then data were analyzed using SPSS software version 22 and descriptive and analytical tests were used as appropriated. RESULTS Although the duct cleaning and the complete removal of the stones in the stenting treatment procedure was 93.8%, and in EPBD was 78.3%, no significant difference was observed between the two groups (p = 0.14). Pancreatitis significantly increased after the first and second endoscopic retrograde cholangiopancreatography (ERCP) in the stent group compared with EPBD (p = 0.02). Also, the most frequent cases of isolated pain were in the endoscopic group EPBD (p = 0.0). However, the occurrence of perforation after first ERCP and EPBD was zero, but in the second stage of ERCP, 3.3% of the patients had perforations (p = 0.99). The results indicated that the shape of the stone (circular and angled) was not effective in the result of treatment in the two groups. CONCLUSION The results of this study indicated that in case of experience and skill in conducting the ERCP, common bile duct stenting is still the first line of treatment for large and multiple stones of the common bile ducts.
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Affiliation(s)
- Ahmad Hormati
- Assistant Professor, Gastroenterology and Hepatology Disease Research Center, Qom University of Medical Sciences, Shahid Beheshti Hospital, Qom, Iran.,Assistant Professor, Gastrointestinal and Liver Disease Research Center, Iran University of Medical Sciences, Firoozgar Hospital, Tehran, Iran
| | - Mohammad Reza Ghadir
- Professor, Gastroenterology and Hepatology Disease Research Center, Qom University of Medical Sciences, Shahid Beheshti Hospital, Qom, Iran
| | - Ali Hasanpour Dehkordi
- Associate Professor, School of Allied Medical Sciences, Shahrekord, University of Medical Sciences, Shahrekord, Iran
| | - Farshad Yadollahi
- Medical Resident, Medical College, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Shahriar Salehitali
- Assistant Professor , School of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mahboobeh Afifian
- MSc of Health Information Technology of Tehran University of Medical Sciences, Tehran, Iran
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Ding H, Zhou P, Xu M, Chen W, Li Q, Chen T, Cai M, Chen T, Lian J, Zhang Y. Combining endoscopic ultrasound and tumor markers improves the diagnostic yield on the etiology of common bile duct dilation secondary to periampullary pathologies. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:314. [PMID: 31475184 DOI: 10.21037/atm.2019.06.51] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background Unexplained common bile duct (CBD) dilatation may be caused by many etiologies, such as periampullary tumors, a pancreatic neoplasm, choledocholithiasis or an inflammatory stenosis. The aim of this study is to evaluate the diagnostic yield of endoscopic ultrasonography (EUS) in patients with unexplained CBD dilatation, in combination with tumor markers, liver chemistry, symptoms, surgical history and whether there is dilatation of the pancreatic duct (PD). Methods From January 2016 to July 2017, 115 patients were referred for EUS in our center for CBD dilatation of an unknown etiology. A treatment plan is made based on the EUS result combined with the other clinical information. The final diagnosis is determined by surgical histology or follow-up of at least 3 months. Results The sensitivity, specificity and accuracy of EUS for patients with choledocholithiasis were 100.0% (10/10), 100.0% (105/105) and 100.0% (115/115), respectively. The sensitivity, specificity and accuracy of EUS for patients with periampullary tumor were 86.5% (32/37), 89.7% (70/78) and 88.7% (102/115), respectively. The sensitivity, specificity and accuracy of EUS for patients with inflammatory stenosis were 88.2% (60/68), 89.4% (42/47) and 88.7% (102/115), respectively. The overall accuracy of EUS for diagnosing an undetermined etiology for CBD dilatation was 88.7% (102/115) and was higher than the accuracy of ultrasound (US) (64.1%), computed tomography (CT) (66.2%), magnetic resonance imaging (MRI) (67.0%) or PET-CT (66.0%). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of EUS combined with tumor markers for patients with malignant dilatation of CBD were 91.9% (34/37), 97.4% (76/78), 94.4% (34/36), 96.2% (76/79) and 95.7% (110/115), respectively. PD dilation (P=0.026) and weight loss (P=0.035) had significant predictive values of malignancy. Conclusions EUS is an effective diagnostic tool for determining the etiology of a CBD dilatation, and offers meaningful information for guiding a treatment plan. EUS used in conjunction with tumor markers has high yield in differentiating benign and malignant CBD dilatation. More attention should be paid to patients with PD dilation or weight loss to prevent misdiagnosis of malignant CBD dilation.
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Affiliation(s)
- Han Ding
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Pinghong Zhou
- Endoscopy center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Meidong Xu
- Endoscopy center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Weifeng Chen
- Endoscopy center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Quanlin Li
- Endoscopy center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Tao Chen
- Endoscopy center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Mingyan Cai
- Endoscopy center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Tianyin Chen
- Endoscopy center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jingjing Lian
- Endoscopy center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yiqun Zhang
- Endoscopy center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Yang T, Ma Z, Xu B, Sun W, Meng H, Liu D, Zhou B, Song Z. Clinical role of frequency-doubled double-pulse neodymium YAG laser lithotripsy for removal of difficult biliary stones in laparoscopic common bile duct exploration. ANZ J Surg 2019; 89:E358-E362. [PMID: 31441206 DOI: 10.1111/ans.15364] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND The optimal methods for patients with difficult biliary stones remain under debate. The aim of this study was to evaluate the role of frequency-doubled double-pulse neodymium YAG (FREDDY) laser lithotripsy for removing difficult biliary stones during laparoscopic common bile duct exploration (LCBDE). METHODS Between March 2013 and January 2015, 42 consecutive patients with difficult biliary stones who underwent LCBDE with FREDDY laser lithotripsy were included in this study. The clinical data of all patients were retrospectively collected and analysed. RESULTS Bile ducts were completely cleared in all patients. The complications related to laser lithotripsy were not noted. A total of 38 patients (90.5%) underwent primary closure of common bile duct, and T-tube drainage was applied to four patients (9.5%). No bile duct injury, bleeding and perforation were observed. There were no post-operative surgery-related deaths. Bile leakage occurred in four patients (9.5%) with primary closure procedure, and all of them were managed successfully with conservative therapy. The median follow-up period was 42.8 months, with no evidence of bile duct stricture and stone recurrence in all patients. CONCLUSIONS The LCBDE combined with FREDDY laser lithotripsy appear to be effective and safe for the treatment of difficult biliary stones.
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Affiliation(s)
- Tingsong Yang
- Department of Hepatobiliary and Pancreatic Surgery, Cholelithiasis Treatment Center, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China
| | - Zhilong Ma
- Department of Hepatobiliary and Pancreatic Surgery, Cholelithiasis Treatment Center, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China
| | - Bin Xu
- Department of Hepatobiliary and Pancreatic Surgery, Cholelithiasis Treatment Center, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China
| | - Wei Sun
- Department of Hepatobiliary and Pancreatic Surgery, Cholelithiasis Treatment Center, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China
| | - Hongbo Meng
- Department of Hepatobiliary and Pancreatic Surgery, Cholelithiasis Treatment Center, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China
| | - Dalu Liu
- Department of Hepatobiliary and Pancreatic Surgery, Cholelithiasis Treatment Center, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China.,Department of General Surgery, Shanghai Clinical Medical College of Anhui Medical University, Shanghai, China
| | - Bo Zhou
- Department of Hepatobiliary and Pancreatic Surgery, Cholelithiasis Treatment Center, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China
| | - Zhenshun Song
- Department of Hepatobiliary and Pancreatic Surgery, Cholelithiasis Treatment Center, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China
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Kimura K, Kudo K, Yoshizumi T, Kurihara T, Yoshiya S, Mano Y, Takeishi K, Itoh S, Harada N, Ikegami T, Ikeda T. Electrohydraulic lithotripsy and rendezvous nasal endoscopic cholangiography for common bile duct stone: A case report. World J Clin Cases 2019; 7:1149-1154. [PMID: 31183346 PMCID: PMC6547329 DOI: 10.12998/wjcc.v7.i10.1149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 03/20/2019] [Accepted: 03/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND In patients with large stones in the common bile duct (CBD), advanced treatment modalities are generally needed. Here, we present an interesting case of a huge CBD stone treated with electrohydraulic lithotripsy (EHL) by the percutaneous approach and rendezvous endoscopic retrograde cholangiography (ERC) using a nasal endoscope.
CASE SUMMARY A 91-year-old woman underwent ERC for a symptomatic large CBD stone with a diameter of 50 mm. She was referred to our institution after the failure of lithotomy by ERC, and after undergoing percutaneous transhepatic biliary drainage. We attempted to fragment the stone by transhepatic cholangioscopy using EHL. However, the stones were too large and partly soft clay-like for lithotripsy. Next, we attempted lithotomy with ERC and cholangioscopy by the rendezvous technique using a nasal endoscope and achieved complete lithotomy. No complication was observed at the end of this procedure.
CONCLUSION Cholangioscopy by rendezvous technique using a nasal endoscope is a feasible and safe endoscopic method for removing huge CBD stones.
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Affiliation(s)
- Koichi Kimura
- Department of Endoscopy and Endoscopic Surgery, Fukuoka Dental College, Fukuoka 814-0175, Japan
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Kensuke Kudo
- Department of Endoscopy and Endoscopic Surgery, Fukuoka Dental College, Fukuoka 814-0175, Japan
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Takeshi Kurihara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Shohei Yoshiya
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Yohei Mano
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Kazuki Takeishi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Shinji Itoh
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Noboru Harada
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Toru Ikegami
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Tetsuo Ikeda
- Department of Endoscopy and Endoscopic Surgery, Fukuoka Dental College, Fukuoka 814-0175, Japan
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
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Bilirubin Correlation May Preclude MRCP in Acute Cholecystitis Patients With Normal Common Bile Duct Diameter. AJR Am J Roentgenol 2019; 212:1018-1023. [PMID: 30860886 DOI: 10.2214/ajr.18.20613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. In patients with acute cholecystitis (AC), accurate identification of a common bile duct (CBD) stone before cholecystectomy is of concern for surgeons, gastroenterologists, and radiologists. This study evaluates the utility of preoperative MRCP taking into consideration both sonographic findings and biochemical predictors for choledocholithiasis. MATERIALS AND METHODS. Fifty-seven patients (58% women; mean age, 54 years old) with signs of AC on right upper quadrant (RUQ) ultrasound (US) who underwent subsequent MRCP from 2007 to 2017 were identified using a text-based search and retrospectively analyzed, using ERCP as the reference standard. RESULTS. For patients with AC who had a normal CBD diameter on initial RUQ US, we found a significant difference in the total and direct bilirubin levels of patients who had positive (1.94 vs 4.02 mg/dL, respectively; p = 0.013) and negative (0.71 vs 2.13 mg/dL, respectively; p = 0.02) findings for CBD stone on MRCP. ROC curve analysis showed an increased total bilirubin threshold of > 2.3 mg/dL (standard threshold, 1.2 mg/dL), which yielded a negative predictive value (NPV) of 95%. An increased direct bilirubin threshold of > 0.9 mg/dL (standard threshold, 0.2 mg/dL) yielded an NPV of 100%. CONCLUSION. In patients with AC who have a normal CBD diameter on RUQ US, normal or even mildly elevated bilirubin levels below a calculated threshold may obviate preoperative MRCP. Radiologists should be active participants in clinical decision-making; discussion between referring physicians and radiologists regarding biochemical markers and sonographic findings will lead to more appropriate use of preoperative imaging.
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Radwan MI, Emara MH, Ibrahim IM, Moursy ME. Large Balloon Dilatation Versus Mechanical Lithotripsy After Endoscopic Sphincterotomy in the Management of Large Common Bile Duct Stones in Cirrhotic Patients: A Randomized Study. J Clin Gastroenterol 2019; 53:e150-e156. [PMID: 29521723 DOI: 10.1097/mcg.0000000000001000] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIM Removal of large common bile duct (CBD) stones is one of the challenges faced during endoscopic retrograde cholangiopancreatography, and it seems more difficult in cirrhotic patients because of suspected higher rates of adverse events, especially bleeding diathesis. This study aimed at comparing the success rate and complications between mechanical lithotripsy (ML) and large balloon dilation (LBD) after endoscopic sphincterotomy in patients with liver cirrhosis. PATIENTS AND METHODS Ninety-eight cirrhotic patients with calcular obstructive jaundice were included and randomly divided into 2 groups: group A comprising 49 patients treated by LBD and group B comprising 49 patients treated by ML. All patients underwent sphincterotomy initially. All patients were subjected to thorough history taking and complete clinical examination. Pancreatic enzyme concentrations were measured 4 hours before and 24 hours after the procedure, and complete blood cell count and liver function tests were performed before and the morning after the procedure. Before and during endoscopic retrograde cholangiopancreatography, stone size and number were verified. RESULTS The success rate for CBD clearance was 98% and 93.8% for LBD and ML, respectively. The rate of adverse events in this study was 10.2% (10/98), and bleeding was the commonest reported complication (5/10). Group B developed more (16.3%) adverse events than group A (4.1%), and the difference was statistically significant (P=0.04). CONCLUSION Endoscopic sphincterotomy followed by LBD is a safe and effective treatment for large CBD stones in cirrhotic patients in comparison with sphincterotomy followed by ML.
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Affiliation(s)
- Mohamed I Radwan
- Tropical Medicine Department, Faculty of Medicine, Zagazig University
| | - Mohamed H Emara
- Tropical Medicine Department, Faculty of Medicine, Zagazig University
- Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Ibrahim M Ibrahim
- Tropical Medicine Department, Faculty of Medicine, Zagazig University
| | - Mahmoud E Moursy
- Gastroenterology Department, Al-Ahrar Teaching Hospital, Zagazig
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Martins T, Amante LN, Virtuoso JF, Sell BT, Wechi JS, Senna CVA. FATORES DE RISCO PARA INFECÇÃO DO SÍTIO CIRÚRGICO EM CIRURGIAS POTENCIALMENTE CONTAMINADAS. TEXTO & CONTEXTO ENFERMAGEM 2018. [DOI: 10.1590/0104-070720180002790016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
RESUMO Objetivo: associar os fatores de risco do período pós-operatório de cirurgias potencialmente contaminadas, com a ocorrência da infecção do sítio cirúrgico no período pós-operatório hospitalar e domiciliar. Método: período de coleta de dados foi de fevereiro a junho de 2015, com 84 pacientes acompanhados nos três primeiros dias de pós-operatório e sete dias após a alta hospitalar, através de questionários elaborados para avaliação do sítio cirúrgico, das condições clínicas do paciente e da análise de prontuário. Para verificação dos fatores de risco influenciáveis e classificação das infecções do sítio cirúrgico, utilizou-se um questionário com variáveis que foram analisadas de forma descritiva através da frequência simples, porcentagem e medidas de posição e dispersão. Para a associação e nível de significância dos fatores de risco foram realizados testes estatísticos. Resultados: nenhum dos pacientes entrevistados desenvolveu infecção profunda do sítio cirúrgico ou de órgão/espaço, sendo que sete desenvolveram infecção do sítio cirúrgico superficial no pós-operatório hospitalar e 41 em domicílio. Os fatores de risco analisados não foram significativos para o desenvolvimento das infecções. Conclusões: recomenda-se que as instituições implantem um serviço de vigilância e acompanhamento pós-alta, a fim de que se melhore a confiabilidade das taxas de incidência das infecções do sítio cirúrgico; melhorar a qualidade dos cuidados com os pacientes; compreensão epidemiológica e identificação dos fatores de risco. Além disso, propõe-se facilitar o processo de referência e contra referência através de capacitações da Estratégia de Saúde da Família para identificação destes fatores de risco, atuando em rede.
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Affiliation(s)
- Tatiana Martins
- Estratégia de Saúde da Família do Município de Biguaçu, Brasil
| | | | | | - Bruna Telemberg Sell
- Secretaria Municipal de Saúde do Município de São José, Brasil; Hospital Governador Celso Ramos, Brasil
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Virzì V, Ognibene NMG, Sciortino AS, Culmone G, Virzì G. Routine MRCP in the management of patients with gallbladder stones awaiting cholecystectomy: a single-centre experience. Insights Imaging 2018; 9:653-659. [PMID: 29978345 PMCID: PMC6206385 DOI: 10.1007/s13244-018-0640-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/25/2018] [Accepted: 05/28/2018] [Indexed: 01/14/2023] Open
Abstract
Objectives To assess the frequency of choledocolithiasis and the role of preoperative laboratory findings, ultrasound (US) and magnetic resonance cholangio-pancreatography (MRCP) in the detection of choledocolithiasis in patients with gallbladder stones awaiting cholecystectomy. Methods A consecutive sample of 104 patients underwent MRCP prior to cholecystectomy. The patients were classified into different groups on the basis of the risk of choledocolithiasis. A specialised doctor with more 10 years of experience performed the US interpretation and a radiologist performed the MRCP interpretation blinded to US or aspartate aminotransferase (AST)/alanine aminotransferase (ALT)/alkaline phosphatase (ALP) results. A chi-square (χ2) test was performed to assess the statistical significance of differences in the frequency of choledocolithiasis based on laboratory findings, choledocal diameter on US and group risk. Results MRCP showed calculi in 7 out of 104 patients (6.7%), with no statistically significant differences between the high/moderate risk and low/no risk groups and between the patients with normal and altered laboratory findings or choledocal diameter on preoperative US. The sensitivity and specificity of AST/ALT [positive predictive value (PPV): 12%; negative predictive value (NPV): 94%], ALP (PPV: 7%; NPV: 94%), total serum bilirubin (PPV: 6%; NPV: 93%) and choledocal diameter (PPV: 20%; NPV: 94%) were, respectively, 28.6 and 94.8%, 85.7 and 17.5%, 14.3 and 93.8%, and 14.3 and 95.9%. Conclusions MRCP is a reliable evaluation for the detection of common bile duct (CBD) stones, reducing the misdiagnosis of retained choledocholithiasis with normal biochemical predictors and US examination. Main messages • MRCP is a non-invasive method for the detection of CBD stones. • Preoperative MRCP reduces the misdiagnosis of retained choledocholithiasis. • Detection of choledocholithiasis is mandatory prior to cholecystectomy to avoid surgical morbidity
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Affiliation(s)
- Valentina Virzì
- Department of Radiology, "Regina Pacis" Clinic, via Principe Lanza di Scalea 3/5, 93017, San Cataldo, CL, Italy
| | | | - Antonio Salvatore Sciortino
- Department of Surgery, "Regina Pacis" Clinic, via Principe Lanza di Scalea 3/5, 93017, San Cataldo, CL, Italy
| | - Glenda Culmone
- "Regina Pacis" Clinic, Skema Iniziative Sanitarie, via Principe Lanza di Scalea 3/5, 93017, San Cataldo, CL, Italy
| | - Giuseppe Virzì
- Department of Surgery, "Regina Pacis" Clinic, via Principe Lanza di Scalea 3/5, 93017, San Cataldo, CL, Italy
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Gallstone Pancreatitis and Choledocholithiasis: Using Imaging and Laboratory Trends to Predict the Likelihood of Persistent Stones at Cholangiography. World J Surg 2018; 42:3143-3149. [DOI: 10.1007/s00268-018-4618-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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46
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Doshi B, Yasuda I, Ryozawa S, Lee GH. Current endoscopic strategies for managing large bile duct stones. Dig Endosc 2018; 30 Suppl 1:59-66. [PMID: 29658655 DOI: 10.1111/den.13019] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 01/11/2018] [Indexed: 12/14/2022]
Abstract
Common bile duct stones are a relatively common occurrence and can often lead to devastating complications. Endoscopic retrograde cholangiopancreatography was introduced in the 1970s for management of common bile duct stones. Most common bile duct stones can be removed with simple techniques such as endoscopic sphincterotomy and balloon trawling. However, large bile duct stones continue to pose some difficulty in achieving complete extraction. In this article, we will review some of the established techniques such as the use of endoscopic papillary large balloon dilatation, mechanical lithotripsy, and cholangioscopy-assisted techniques. We will look at the recent literature to help clarify the particular methods and answer some of the questions surrounding these methods.
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Affiliation(s)
- Bhavesh Doshi
- National University Health System, Division of Gastroenterology and Hepatology, University Medicine Cluster, Singapore
| | - Ichiro Yasuda
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - Shomei Ryozawa
- Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Guan Huei Lee
- National University Health System, Division of Gastroenterology and Hepatology, University Medicine Cluster, Singapore
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47
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Abstract
In this retrospective study of real-life data, we aimed to determine the diagnostic accuracy in patients with choledocholithiasis of some current imaging modalities, including ultrasonography (US), computerized tomography (CT), magnetic resonance cholangiopancreatography (MRCP), and endoscopic retrograde cholangiopancreatography (ERCP). This study utilized a database of imaging records from 86 consecutive patients with ERCP-proven choledocholithiasis in a single-center outpatient clinic. Features of the stones found, namely number, size, localization, choledochal dilation and cholestasis, were determined using various imaging modalities and liver function tests (LFTs). Our study focused on a total of 86 patients (43 female; 43 male) who underwent the ERCP procedure. Hepatobiliary ultrasound was performed in 71 (82.6%); MRCP in 59 (68.6%); and CT in 13 (15.1%) patients. All 86 patients had choledocholithiasis: 59 (68.6%) with multiple stones and 21 (24.4%) with stones over 10 mm in diameter. Sensitivity for the presence of choledocholithiasis was 40.8% for US, 76.9% for CT, and 86.4% for MRCP, where ERCP was taken as the reference method. Even though US, CT, and MRCP are widely used as noninvasive imaging modalities for CL, in our real-life data their sensitivity for choledocholithiasis was lower than expected. MRCP is preferred when a nontherapeutic but only diagnostic evaluation is aimed for; however, while highly competent in establishing the level of choledochal dilation, it had a low yield in differentiating the localization, size, and number of the stone(s).
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48
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Kleinubing DR, Riera R, Matos D, Linhares MM. Selective versus routine intraoperative cholangiography for cholecystectomy. Hippokratia 2018. [DOI: 10.1002/14651858.cd012971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Diego R Kleinubing
- Universidade Federal do Pampa; Department of Surgery, Faculty of Medicine; Uruguaiana Rio Grande do Sul Brazil
| | - Rachel Riera
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde; Cochrane Brazil; Rua Borges Lagoa, 564 cj 63 São Paulo SP Brazil 04038-000
| | - Delcio Matos
- Escola Paulista de Medicina, Universidade Federal de São Paulo; Department of Gastroenterological Surgery; Rua Edison 278, Apto 61 Campo Belo São Paulo São Paulo Brazil 04618-031
| | - Marcelo Moura Linhares
- Universidade Federal de São Paulo; Department of Surgery; Rua Leandro Dupre, 334. Ap-21 Sao Paulo SP Brazil 04025011
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Al-Aubaidi T, Ghadhban BR, Chitheer SS. Does preoperative magnetic resonant cholangiopancreatography (MRCP), improve the safety of laparoscopic cholecystectomy? INTERNATIONAL JOURNAL OF SURGERY OPEN 2018. [DOI: 10.1016/j.ijso.2018.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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50
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Revzin MV, Scoutt LM, Garner JG, Moore CL. Right Upper Quadrant Pain: Ultrasound First! JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1975-1985. [PMID: 28586152 DOI: 10.1002/jum.14274] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 01/27/2017] [Indexed: 06/07/2023]
Abstract
Acute right upper quadrant (RUQ) pain is a common presenting symptom in emergency departments and outpatient medical practices, and is most commonly attributable to biliary and hepatic pathology. Ultrasound should be used as a first-line imaging modality for the diagnosis of gallstones and cholecystitis, as it allows the differentiation of medical and surgical causes of upper abdominal pathology, and in many circumstances is sufficient to guide patient management. Knowledge of strengths and limitations of ultrasound in the evaluation of RUQ is paramount in correct diagnosis. A spectrum of RUQ pathology for which a RUQ ultrasound examination should reasonably be considered as the initial imaging modality of choice will be reviewed.
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Affiliation(s)
- Margarita V Revzin
- Department of Diagnostic Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Leslie M Scoutt
- Department of Diagnostic Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Joseph G Garner
- Department of Medicine and Infectious Diseases, Hospital of Central Connecticut, New Britain, Connecticut, USA
| | - Christopher L Moore
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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