Endoscopic Retrograde Cholangiopancreatography Prior to Laparoscopic Cholecystectomy

Alkhaffaf, Bilal; Parkin, Edward T.; Flook, David

doi:10.1001/archsurg.2011.30

Cited by 22 publications

(15 citation statements)

References 32 publications

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“…Occurrence of gallstones is common in elderly patients. Approximately 5.1-7.2% of patients undergoing cholecystectomy for gallstones have CBD stones [6,7]. With advanced age, CBD stones occur more frequently [8].…”

Section: Discussionmentioning

confidence: 99%

Micro-Incision of the Cystic Duct Confluence in Laparoscopic Common Bile Duct Exploration for Elderly Patients with Choledocholithiasis

Niu

Song

et al. 2016

Indian J Surg

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Common bile duct (CBD) stones are common in elderly patients. The laparoscopic transcystic approach with micro-incision of the cystic duct confluence in common bile duct exploration (LTM-CBDE) is a modified laparoscopic transcystic approach. Its safety and efficacy have not been studied in elderly patients with secondary choledocholithiasis. This study evaluates the safety and efficacy of LTM-CBDE in elderly (≥65 years) patients with secondary choledocholithiasis and compares the results with those in younger patients. In this retrospective analysis, 128 patients underwent LTM-CBDE from March 2007 to December 2013. The patients were divided into two groups according to age: the elderly group consisted of 50 patients aged ≥65 years and the younger group consisted of 78 patients aged <65 years. The preoperative morbidity rate, American Society of Anesthesiologists (ASA) score, previous abdominal operations, operation time, postoperative hospital stay, open conversion rate, postoperative complication rate, residual stone rate, recurrence rate and mortality were compared in both groups. The preoperative morbidity (41 vs. 28) and ASA score (2.5 ± 0.7 vs. 1.8 ± 0.6) were higher in the elderly group ( = 0.000, in both groups). No significant differences in previous abdominal operations, operation time, postoperative hospital stay, open conversion rate, postoperative complication rate, residual stone rate, recurrence rate and mortality ( > 0.05) were found between the two groups from March 2007 to December 2013. LTM-CBDE is a safe and effective treatment procedure for elderly patients with secondary choledocholithiasis. For suitable patients, we recommend LTM-CBDE as the treatment of choice.

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Section: Discussionmentioning

confidence: 99%

Micro-Incision of the Cystic Duct Confluence in Laparoscopic Common Bile Duct Exploration for Elderly Patients with Choledocholithiasis

Niu

Song

et al. 2016

Indian J Surg

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“…This estimate assumes 32,300 cases of suspected CBD stones each year (based on 50 million adults in the UK,[ 41 ] a prevalence of gallstones of 15%,[ 21 ] that 2% of gallstones are symptomatic each year,[ 42 ] that 9% of these are due to CBD stones,[ 43 – 45 ] and a pre-test probability of CBD stones of 0.418]. [ 21 ] There is no evidence on the use of EUS versus MRCP to diagnose CBD stones in the UK[ 46 ] but if 50% of CBD stones are already diagnosed using MRCP and 50% are diagnosed using EUS then the cost saving would still be $4.8 million. [ 39 ]…”

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness Analysis of Endoscopic Ultrasound versus Magnetic Resonance Cholangiopancreatography in Patients with Suspected Common Bile Duct Stones

et al. 2015

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BackgroundPatients with suspected common bile duct (CBD) stones are often diagnosed using endoscopic retrograde cholangiopancreatography (ERCP), an invasive procedure with risk of significant complications. Using endoscopic ultrasound (EUS) or Magnetic Resonance CholangioPancreatography (MRCP) first to detect CBD stones can reduce the risk of unnecessary procedures, cut complications and may save costs.AimThis study sought to compare the cost-effectiveness of initial EUS or MRCP in patients with suspected CBD stones.MethodsThis study is a model based cost-utility analysis estimating mean costs and quality-adjusted life years (QALYs) per patient from the perspective of the UK National Health Service (NHS) over a 1 year time horizon. A decision tree model was constructed and populated with probabilities, outcomes and cost data from published sources, including one-way and probabilistic sensitivity analyses.ResultsUsing MRCP to select patients for ERCP was less costly than using EUS to select patients or proceeding directly to ERCP ($1299 versus $1753 and $1781, respectively), with similar QALYs accruing to each option (0.998, 0.998 and 0.997 for EUS, MRCP and direct ERCP, respectively). Initial MRCP was the most cost-effective option with the highest monetary net benefit, and this result was not sensitive to model parameters. MRCP had a 61% probability of being cost-effective at $29,000, the maximum willingness to pay for a QALY commonly used in the UK.ConclusionFrom the perspective of the UK NHS, MRCP was the most cost-effective test in the diagnosis of CBD stones.

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“…Common bile duct (CBD) stones are present in 3.4–7.2% of patients presenting for a cholecystectomy 1–3 …”

Section: Introductionmentioning

confidence: 99%

Meta-analysis of one- vs. two-stage laparoscopic/endoscopic management of common bile duct stones

Alexakis

Connor

2012

HPB

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Endoscopic Retrograde Cholangiopancreatography Prior to Laparoscopic Cholecystectomy

Cited by 22 publications

References 32 publications

Micro-Incision of the Cystic Duct Confluence in Laparoscopic Common Bile Duct Exploration for Elderly Patients with Choledocholithiasis

Micro-Incision of the Cystic Duct Confluence in Laparoscopic Common Bile Duct Exploration for Elderly Patients with Choledocholithiasis

Cost-Effectiveness Analysis of Endoscopic Ultrasound versus Magnetic Resonance Cholangiopancreatography in Patients with Suspected Common Bile Duct Stones

Meta-analysis of one- vs. two-stage laparoscopic/endoscopic management of common bile duct stones

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