Role of endoscopic retrograde cholangiopancreatography in the management of suspected choledocholithiasis

Sharma, Sanjeev; Larson, Kenneth A.; Adler, Z; Goldfarb, Michael A.

doi:10.1007/s00464-002-8704-2

Cited by 19 publications

(9 citation statements)

References 12 publications

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“…Also magnetic resonance cholangiopancreatography (MRCP) and endoscopic US could approach the diagnostic value of ERCP without complications [17]. However, ERCP performed on selected/restricted indications have higher diagnostic and therapeutic advantages [1, 18]. In order to predict CBDS risk, the American Society for Gastrointestinal Endoscopy (ASGE) guidelines mention CBDS risk categories and treatment modalities: in high risk patients, ERCP is the first intervention; in the median risk group endosonography US and MRCP are recommended or, if not available, ERCP is again recommended [19].…”

Section: Discussionmentioning

confidence: 99%

The timing of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreaticography in cholelithiasis coexisting with choledocholithiasis

Salman

Yılmaz

Kerem

et al. 2009

J Hepatobiliary Pancreat Surg

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Section: Discussionmentioning

confidence: 99%

The timing of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreaticography in cholelithiasis coexisting with choledocholithiasis

Salman

Yılmaz

Kerem

et al. 2009

J Hepatobiliary Pancreat Surg

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“…MRCP is a noninvasive modality and has been widely applied to demonstrate the structural abnormalities of the biliary tract,18, 19 especially in patients suffering from choledochal cysts and choledocholithiasis 2, 20–25. Because identification of the pertinent biliary anatomy and variations helps to reduce the complication rate of liver transplantation,26–28 MRCP is becoming a popular imaging modality for detailed preoperative imaging of biliary trees in living liver donors 12–17.…”

Section: Discussionmentioning

confidence: 99%

Morphine- and glucagon-augmented magnetic resonance cholangiopancreatography to evaluate living liver donors

Liang

et al. 2009

Liver Transpl

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The purpose of this study was to investigate the effectiveness of the combined use of intravenous morphine and intramuscular glucagon in improving magnetic resonance cholangiopancreatography (MRCP) image quality in donors for living-related liver transplantation. Sixteen healthy donor candidates underwent an MRCP study. Coronal, single-shot, fast spin-echo, heavily T2-weighted dynamic MRCP images were obtained before and 3 minutes after the intravenous administration of morphine HCl with a dose of 0.04 mg/kg. Thirty minutes after the injection of morphine, intramuscular glucagon was used. Another MRCP image of the same pulse sequence was generated 15 minutes after the injection of glucagon with a dose of 1 mg. The diameter, signal intensity, and number of branches of bile ducts in MRCP images taken immediately before and after the injection of morphine and after the injection of glucagon (plus delayed morphine effects) were compared and analyzed. In all 16 donor candidates, the diameters of the right and left hepatic ducts, common bile duct, and main pancreatic duct were significantly increased (P Ͻ 0.05) in the MRCP images taken 3 minutes after the injection of morphine and 15 minutes after the injection of glucagon (plus delayed morphine effects) in comparison with MRCP images taken before any drug administration. The qualitative grading scores of the signal intensity and order of branches of bile ducts revealed improvements in the MRCP images after the injection of glucagon (plus delayed morphine effects; P Ͻ 0.05). In conclusion, combining the intravenous administration of low-dose morphine and the intramuscular use of glucagon before MRCP examination improves the visualization of the nondilated biliary ductal anatomy, which is important for the preoperative biliary evaluation of donor candidates for living-related liver transplantation.

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“…2 However, the optimum method of investigating suspected common bile duct stones is still under debate. MRCP has been shown to be sensitive and specific in the evaluation of choledocholithiasis when compared to ERCP.…”

Section: Magnetic Resonance Cholangiopancreatography (Mrcp) Ismentioning

confidence: 99%

Routine magnetic resonance cholangiopancreatography and intra-operative cholangiogram in the evaluation of common bile duct stones

Dalton

Balupuri²,

Guest³

2005

Ann R Coll Surg Engl

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Magnetic resonance cholangiopancreatography (MRCP) is increasingly replacing diagnostic endoscopic retrograde cholangiopancreatography (ERCP) in the initial assessment of patients suspected biliary obstruction, 1 with ERCP being reserved for the removal of confirmed stones in choledocholithiasis.2 However, the optimum method of investigating suspected common bile duct stones is still under debate. MRCP has been shown to be sensitive and specific in the evaluation of choledocholithiasis when compared to ERCP. [3][4][5][6] It is generally well tolerated 7 and avoids the potential complications of ERCP when used as a diagnostic modality. It has high sensitivity and specificity in the initial evaluation of patients with clinical obstructive jaundice and could replace the direct cholangiography when is used for diagnostic purpose.8 However, the value of information gained at MRCP may be limited if patient selection is inappropriate. The role of routine operative cholangiography is also debated with proponents advocating its use in all cholecystectomies in order to reduce bile duct injuries.10 A move to a more selective approach has also been recommended and has been show to be safe, cost effective and not to increase postoperative complications.11 Its role in identifying uncertain anatomy and visualising choledocholithiasis is well established.12 However, whether IOC provides useful additional information following a normal pre-operative MRCP, when at operation the anatomy is judged to be clear, is not known.When compared with direct cholangiography, (ERCP, PTC and IOC), MRCP has again found to be both sensitive and specific. However, in these studies the numbers of IOCs included have been very small, 3,13,14 and the question of whether a pre-operative MRCP can obviate the need for IOC still remains. We, therefore, conducted this prospective study comparing routine IOC with pre-operative MRCP.

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Role of endoscopic retrograde cholangiopancreatography in the management of suspected choledocholithiasis

Abstract: ERCP is an invasive procedure with significant morbidity that should be used selectively. MRCP may be a more appropriate initial evaluation of suspected CBD pathology in many patients.

Cited by 19 publications

References 12 publications

The timing of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreaticography in cholelithiasis coexisting with choledocholithiasis

The timing of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreaticography in cholelithiasis coexisting with choledocholithiasis

Morphine- and glucagon-augmented magnetic resonance cholangiopancreatography to evaluate living liver donors

Routine magnetic resonance cholangiopancreatography and intra-operative cholangiogram in the evaluation of common bile duct stones

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