Intraoperative cholangiography versus magnetic resonance cholangiography in patients with mild acute biliary pancreatitis

Abstract

Cholecystectomy is the only definitive management of pancreatitis secondary to gallstone disease. Approximately 20% to 30% of patients with acute biliary pancreatitis (ABP) will have persistent common bile duct (CBD) stones. Therefore, choosing a method for the early diagnosis of choledocholithiasis is essential to reduce waiting days for surgery and hospital stay in these patients.The aim of this study was to compare the use of magnetic resonance cholangiography (MRC) and intraoperative cholangiography (IOC), and its impact on the length of the hospital stay in patients with mild ABP and an intermediate probability of choledocholithiasis.We prospectively evaluated all patients diagnosed with mild ABP and an intermediate probability of choledocholithiasis at admission and 48 hours after, from June, 2017 to December, 2017. Study subjects were identified upon admission and were classified into 2 groups of patients according to their choledocholithiasis predictors; a MRC was performed in the group 1, and an IOC was done in group 2.In all, 47 patients were enrolled in the final analysis of this study. Hospital stay in group 1 (CMR) patients was 8.29 (±2.69) days compared with 6.43 (±2.57) days in the group 2 (IOC) (P = .007). Mean waiting days for cholecystectomy was 17.14 (±26.04) days for group 1 and 5 (±2.69) days for group 2.We suggest an IOC as the election method for the diagnosis of CBD stones in patients with mild ABP in medical centers similar to ours because it reduces waiting days for surgery and hospital stay compared to the MRC.

Single Setting ERCP and Laparoscopic Cholecystectomy is a Safe Procedure in Patients with Cholecysto-Choledocholithiasis: A Prospective Study in a Peripheral-Level Hospital

“…[4][5][6] Laparoscopic cholecystectomy with or without intraoperative cholangiogram (IOC) is the current gold standard for the treatment of acute or chronic cholecystitis. [7][8][9] There is no single method or algorithm that is superior to others when it comes in the treatment of the obstructive complication of calculous biliary diseases like jaundice, pancreatitis, cholangitis, and asymptomatic choledocholithiasis. 8,10 There has been a drastic transformation in the management of CBD stones after the introduction of ERCP in 1968.…”