Is routine MR cholangiopancreatography (MRCP) justified prior to cholecystectomy?

Nebiker, Christian A.; Baierlein, Sammy A.; Beck, Steven; Flüe, Markus von; Ackermann, Christoph; Peterli, Ralph

doi:10.1007/s00423-008-0447-7

Cited by 45 publications

(30 citation statements)

References 27 publications

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“…They conclude although MRCP is diagnostically useful in the perioperative management in some cases, its routine use in the DRG-era may not be justified due to the costs. 17 On the other hand Yan Qiu et al concluded the accuracy of preoperative ultrasonography for the diagnosis of associated CBD stones for patients with gallstones is not high and routine preoperative MRCP examination is suggested for patients with gallstones to rule out possible concomitant CBD stones. 18 The sensitivity and specificity in detection of CBD stone by MRCP in our study was 100%.…”

Section: Discussionmentioning

confidence: 99%

Pre-operative MRCP: is it necessary before routine laparoscopic cholecystectomy to exclude CBD stone-prospective study in tertiary care hospital

et al. 2017

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Background: Cholelithiasis is a common disease and at present the laparoscopic cholecystectomy is the gold standard treatment. The diagnosis of associated common bile duct stone for patients with gallstones is important for prompt surgical decision, treatment efficacy and patient safety. However, whether upper abdominal ultrasound and Liver function test (LFT) is adequate before doing lap cholecystectomy remains controversial. There are different opinions regarding the routine magnetic resonance cholangiopancreatography (MRCP) to detect the possible presence of common bile duct (CBD) stones before laparoscopic cholecystectomy.Methods: This study was carried on a total of 106 patients who were admitted and treated for gall stone diseases in the Department of General Surgery, GSL General Hospital over a period of 24 months. After admission all cases were subjected for liver function test, USG abdomen and MRCP. The collected observational data was analyzed.Results: Among the 106 patients, a total of 17cases showed concurrent gallstones and choledocholithiasis, 11 cases choledocholithiasis were revealed by ultrasound examination, while 6 cases of choledocholithiasis were not detected by ultrasound examination but were confirmed by MRCP.Conclusions: CBD stone may be missed even in the presence of deranged liver enzymes or dilated CBD in USG abdomen. Hence for patient safety routine preoperative MRCP examination is recommended before doing laparoscopic cholecystectomy to rule out the likelihood of concomitant CBD stones. The cost-effectiveness of such expensive investigation is to be studied further taking into consideration preventive costs and patient morbidity and mortality.

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Section: Discussionmentioning

confidence: 99%

Pre-operative MRCP: is it necessary before routine laparoscopic cholecystectomy to exclude CBD stone-prospective study in tertiary care hospital

et al. 2017

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“…Collins et al [6] reported that in nonjaundiced patients with normal duct son transabdominal ultrasound, the prevalence of CBD stone at the time of cholecystectomy is unlikely to exceed 5%. Considering the prevalence of silent CBD stone of 3%–5% [4561112] and the proportion of patients who might have visited other institutions in whom the diagnosis of CBD stones was potentially missed, our data do not show the prevalence of all retained CBD stones after laparoscopic cholecystectomy, only the prevalence of clinically significant retained CBD stones.…”

Section: Discussionmentioning

confidence: 88%

Prevalence and characteristics of clinically significant retained common bile duct stones after laparoscopic cholecystectomy for symptomatic cholelithiasis

et al. 2016

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PurposeTo investigate the prevalence and clinical features of retained symptomatic common bile duct (CBD) stone detected after laparoscopic cholecystectomy (LC) in patients without preoperative evidence of CBD or intrahepatic duct stones.MethodsOf 2,111 patients who underwent cholecystectomy between September 2007 and December 2014 at Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 1,467 underwent laparoscopic cholecystectomy for symptomatic gallbladder stones and their medical records were analyzed. We reviewed the clinical data of patients who underwent postoperative endoscopic retrograde cholangiopancreatography (ERCP) for clinically significant CBD stones (i.e., symptomatic stones requiring therapeutic intervention).ResultsOverall, 27 of 1,467 patients (1.84%) underwent postoperative ERCP after LC because of clinical evidence of retained CBD stones. The median time from LC to ERCP was 152 days (range, 60–1,015 days). Nine patients had ERCP-related complications. The median hospital stay for ERCP was 6 days.ConclusionThe prevalence of clinically significant retained CBD stone after LC for symptomatic cholelithiasis was 1.84% and the time from LC to clinical presentation ranged from 2 months to 2 years 9 months. Therefore, biliary surgeons should inform patients that retained CBD stone may be detected several years after LC for simple gallbladder stones.

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“…Recent studies have even suggested the systematic use of MRCP in patients with acute cholecystitis to exclude CBDS [1,15,16] . Another option is EUS, an invasive test with a sensitivity of 93% and a specificity of 96% for detection of choledocholithiasis [14] but with a lower morbidity than ERCP.…”

Section: Discussionmentioning

confidence: 99%

“…While some studies have reported an incidence of common bile ducts stones (CBDS) from 9.1 to 16.5% of patients presenting with acute cholecystitis [1,2] , others did not find any relation between acute cholecystitis and choledocholithiasis [3] . A diagnosis of CBDS in these patients is a clinical challenge, since liver tests are already altered by the inflammatory process of the gallbladder [4] and the sensitivity of abdominal ultrasound (US) for choledocholithiasis detection is suboptimal [5,6] .…”

Section: Introductionmentioning

confidence: 99%

Performance of the Choledocholithiasis Diagnostic Score in Patients with Acute Cholecystitis

Gouveia

Loureiro

Ferreira

et al. 2017

GE Port J Gastroenterol

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Introduction: The prevalence of choledocholithiasis among patients with acute cholecystitis is estimated to be between 9 and 16.5%. There are no validated algorithms to predict choledocholithiasis in this group of patients. Aim: The aim of this study was to evaluate the performance of the choledocholithiasis diagnostic score proposed by the American Society for Gastrointestinal Endoscopy, in patients with acute cholecystitis. Material/Methods: A retrospective cross-sectional study, covering a 4-year period at a secondary care hospital, was performed. All patients with an encoded diagnosis of acute cholecystitis and with at least one of the following procedures were included: endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound, magnetic resonance cholangiopancreatography, and intraoperative cholangiography. Results: Among 4,369 patients with the diagnosis of acute cholecystitis, 40 (0.92%) had clinical or sonographic suspicion of choledocholithiasis. Their mean age was 68.1 ± 15 years, and 22 (55%) were men. Thirty-one of the patients included (77.5%) had a high risk of choledocholithiasis, and 9 (22.5%) had an intermediate risk. In 16 (51.6%) of the 31 patients with a high risk, the diagnosis of choledocholithiasis was confirmed. In 2 (22.2%) of the 9 patients with an intermediate risk, the diagnosis of choledocholithiasis was also confirmed. The high risk score for choledocholithiasis had a positive predictive value of 52% and a sensitivity of 89%. The intermediate risk score for choledocholithiasis had a positive predictive value of 22% and a sensitivity of 11%. Discussion and Conclusions: Suspicion of choledocholithiasis in patients with acute cholecystitis was a rare event (<1%). The sensitivity of the high risk score was approximately the same as found in published series with patients with suspected choledocholithiasis overall (86%), while the positive predictive value was substantially lower (52 vs. 79.8%). Therefore, in patients with acute cholecystitis and suspected choledocholithiasis, this score should not be used to screen for common bile duct stones, and a sensitive method should be used prior to ERCP.

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Is routine MR cholangiopancreatography (MRCP) justified prior to cholecystectomy?

Abstract: Although MRCP is diagnostically useful in the perioperative management in some cases, its routine use in the DRG-era may not be justified due to the costs.

Cited by 45 publications

References 27 publications

Pre-operative MRCP: is it necessary before routine laparoscopic cholecystectomy to exclude CBD stone-prospective study in tertiary care hospital

Pre-operative MRCP: is it necessary before routine laparoscopic cholecystectomy to exclude CBD stone-prospective study in tertiary care hospital

Prevalence and characteristics of clinically significant retained common bile duct stones after laparoscopic cholecystectomy for symptomatic cholelithiasis

Performance of the Choledocholithiasis Diagnostic Score in Patients with Acute Cholecystitis

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