Unnecessary endoscopic retrograde cholangiopancreatography associated with the spontaneous passage of common bile duct stones into the duodenum: a multicenter retrospective study

Saito, Hirokazu; Iwasaki, Hajime; Itoshima, Hisashi; Kadono, Yoshihiro; Shono, Toshiyuki; Kamikawa, Kentaro; Uehara, Masayoshi; Urata, Atsushi; Nasu, Jiro; Matsushita, Ikuo; Kakuma, Tatsuyuki; Tada, Shuji

doi:10.1007/s00464-023-09954-3

Cited by 6 publications

(5 citation statements)

References 33 publications

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“…For solitary stones or CBDS smaller than 6 mm detected by MRCP, they can spontaneously pass from the common bile duct into the duodenum. Recognizing this possibility, Saito et al advocated for regular MRCP follow-up instead of unnecessary invasive procedures such as ERCP [ 27 ]. Many patients in our study benefited from MRCP examination.…”

Section: Discussionmentioning

confidence: 99%

Clinical study on the necessity and feasibility of routine MRCP in patients with cholecystolithiasis before LC

Guo,

Fan,

Guo

et al. 2024

BMC Gastroenterol

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Background In the past quite a long time, intraoperative cholangiography(IOC)was necessary during laparoscopic cholecystectomy (LC). Now magnetic resonance cholangiopancreatography (MRCP) is the main method for diagnosing common bile duct stones (CBDS). Whether MRCP can replace IOC as routine examination before LC is still inconclusive. The aim of this study was to analyze the clinical data of patients undergoing LC for cholecystolithiasis, and to explore the necessity and feasibility of preoperative routine MRCP in patients with cholecystolithiasis. Methods According to whether MRCP was performed before operation, 184 patients undergoing LC for cholecystolithiasis in the Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University from January 1, 2017 to December 31, 2018 were divided into non-MRCP group and MRCP group for this retrospective study. The results of preoperative laboratory test, abdominal ultrasound and MRCP, biliary related comorbidities, surgical complications, hospital stay and hospitalization expenses were compared between the two groups. Results Among the 184 patients, there were 83 patients in non-MRCP group and 101 patients in MRCP group. In MRCP group, the detection rates of cholecystolithiasis combined with CBDS and common bile duct dilatation by MRCP were higher than those by abdominal ultrasound (P < 0.05). The incidence of postoperative complications in non-MRCP group (8.43%) was significantly higher (P < 0.05) than that in MRCP group (0%). There was no significant difference in hospital stay (P > 0.05), but there was significant difference in hospitalization expenses (P < 0.05) between the two groups. According to the stratification of gallbladder stone patients with CBDS, hospital stay and hospitalization expenses were compared, and there was no significant difference between the two groups (P > 0.05). Conclusions The preoperative MRCP can detect CBDS, cystic duct stones and anatomical variants of biliary tract that cannot be diagnosed by abdominal ultrasound, which is helpful to plan the surgical methods and reduce the surgical complications. From the perspective of health economics, routine MRCP in patients with cholecystolithiasis before LC does not increase hospitalization costs, and is necessary and feasible.

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Section: Discussionmentioning

confidence: 99%

Clinical study on the necessity and feasibility of routine MRCP in patients with cholecystolithiasis before LC

Guo,

Fan,

Guo

et al. 2024

BMC Gastroenterol

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“…The spontaneous passage was higher for asymptomatic stones, small size stones of <6 mm, and when CBD was not dilated i.e., the diameter was <10 mm. 8 Studies do not support the routine LFTs for all the gallstone patients before elective cholecystectomy because the likelihood of finding CBDs is rare for uncomplicated gallstones in the absence of features of cholangitis, jaundice, and USG findings of dilated CBD of >8 mm in diameter or presence stones in it. 9,10,11 The studies report the prevalence of asymptomatic stones in CBD ranges from 3% to 30%.…”

Section: Preoperative Work-up Before Elective Cholecystectomy Often U...mentioning

confidence: 99%

“…Stones found during diagnostic imaging workup before elective cholecystectomy have been found to increase the rate of ERCPs, in many cases unnecessarily, because in most cases the smaller stones pass spontaneously. 8 The ERCP planned for CBDs found that in 6.2% (78/1260) of cases stones had passed spontaneously during a mean duration of 5 days. The spontaneous passage was higher for asymptomatic stones, small size stones of <6 mm, and when CBD was not dilated i.e., the diameter was <10 mm.…”

Section: Preoperative Work-up Before Elective Cholecystectomy Often U...mentioning

confidence: 99%

Rationale for routine preoperative liver function tests before elective cholecystectomy

Shah

2023

J Patan Acad Health Sci

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Preoperative work-up before elective cholecystectomy often undergoes a range of routine investigations that includes liver function tests (LFTs). There is fear of concomitant common bile duct stones (CBDs) in patients with negative ultrasonography (USG) findings, i.e. with no dilatation of bile ducts or presence of stones in it or clinical features of hepatitis or jaundice. Studies show that clinical practice of preoperative workup of routine liver function tests for every elective cholecystectomy patient is questionable, possibly because of peer pressure or defensive medicine practices or simply a ‘copy-paste’ from the practices of seniors.1,2 Preoperative blanket tests on the pretext of ‘finding any abnormalities’ has poor scientific merits. The preoperative LFTs for uncomplicated, elective cholecystectomy patients rarely add value and do not alter the already planned decision based on symptomatology, history, physical examination, and ultrasound diagnosis of cholelithiasis. The clinical pathway for the management in most cases remains unchanged. The practice of menu-style routine tests adds to the cost and rarely adds further useful information sufficient enough to alter the planned clinical pathway.3

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“…With the continuous development of minimally invasive surgery techniques, the treatment options for cholecystolithiasis with choledocholithiasis are constantly changing. The currently known methods include ERCP + LC and LC + LCBDE [ 3 – 7 ]. However, ERCP is associated with postoperative complications due to a damaged SO [ 8 , 9 ] and increased difficulties in selective LC.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of double endoscopy combined with exploration in the treatment of elderly patients with cholecystolithiasis complicated with choledocholithiasis

Zhao,

Liu,

Huang

2024

BMC Surg

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Objective To investigate the efficacy and safety of laparoscopy combined with choledochoscopy in the treatment of elderly patients with cholecystolithiasis complicated with choledocholithiasis. Methods A retrospective analysis of 114 patients admitted to our hospital from January 2020 to January 2023 was conducted. These patients underwent laparoscopic cholecystectomy combined with choledocholithiasis and were divided into an elderly group (≥ 60 years old) of 63 cases and a young and middle-aged group (< 60 years old) of 51 cases according to age. The efficacy and safety indicators of the two groups of patients were observed, and complications were followed up by telephone within 6 months after surgery. The follow-up deadline was June 2023. Results Among the eligible patients (53 men, 61 women, average age 57 years), all were successfully operated, and 1 case was converted to laparotomy. The elderly and young and middle-aged groups were compared concerning hospitalisation time, bowel sound recovery time, and total postoperative complications, and the differences were statistically significant (P-values were 0.009, 0.006, and 0.039). However, there was no statistically significant difference between the two groups of patients in terms of hospitalisation costs, intraoperative blood loss, operation time, drainage tube removal time, conversion to laparotomy rate, and stone clearance rate (P-values > 0 0.05). Conclusion Strict adherence to surgical standards and enhanced postoperative care resulted in similar efficacy and safety results for double endoscopy combined with the exploration of treatment for elderly and young patients with cholecystolithiasis and choledocholithiasis.

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Unnecessary endoscopic retrograde cholangiopancreatography associated with the spontaneous passage of common bile duct stones into the duodenum: a multicenter retrospective study

Cited by 6 publications

References 33 publications

Clinical study on the necessity and feasibility of routine MRCP in patients with cholecystolithiasis before LC

Clinical study on the necessity and feasibility of routine MRCP in patients with cholecystolithiasis before LC

Rationale for routine preoperative liver function tests before elective cholecystectomy

Efficacy and safety of double endoscopy combined with exploration in the treatment of elderly patients with cholecystolithiasis complicated with choledocholithiasis

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