Evaluation of patients with abnormalities on intraoperative cholangiogram: time to abandon endoscopic retrograde cholangiopancreatography as the initial follow-up study

Bill, Jason G.; Kushnir, Vladimir; Mullady, Daniel; Murad, Faris; Azar, Riad R.; Easler, Jeffery J.; Early, Dayna S.; Edmundowicz, Steven A.

doi:10.1136/flgastro-2015-100597

Cited by 7 publications

(8 citation statements)

References 21 publications

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“…In accordance, other previous studies have also concluded that there is no significant correlation between abnormal liver function and spontaneous discharge of stones. 6,21 Perhaps we lacked a dynamic observation process. Khoury et al showed that improved c-GGT levels predicted spontaneous CBD stone passage.…”

Section: Discussionmentioning

confidence: 99%

“…5 However, ERCP is an invasive procedure that is associated with several complications, including post-ERCP pancreatitis, retroperitoneal perforation, and post-sphincterotomy bleeding. 6,7 Moreover, some CBD stones can spontaneously pass through the papilla. Previous studies have shown that stones with diameters <5 mm were more likely to spontaneously pass.…”

Section: Introductionmentioning

confidence: 99%

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Factors related to the spontaneous passage of common bile duct stones through the papilla: a single-center retrospective cohort study

et al. 2021

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Objective Common bile duct (CBD) stones can spontaneously pass through the papilla. This study explored factors associated with stone passage by comparing differences in the clinical features of stones retained in the CBD and excreted stones. Methods Data were retrospectively collected for all patients who were hospitalized in our center between March 2016 and May 2021 with clinical, laboratory, or imaging evidence of CBD stones. All patients underwent endoscopic retrograde cholangiopancreatography (ERCP) and were classified into two groups: group A (stones extracted by ERCP, n = 86) and group B (stones discharged before ERCP, n = 15). Demographic data, biochemical and radiological findings were compared between the groups. Results Stone size (0.82 vs. 0.33 cm), and levels of total bilirubin (58.2 vs. 28.8 μmol/L), gamma-glutamyl transpeptidase (416.7 vs. 193.9 U/L), alkaline phosphatase (191.9 vs. 123.1 U/L), carbohydrate antigen 19-9 (603.7 vs. 37.2 U/mL), and α-L-fucosidase (37.4 vs. 22.6 U/L) were significantly higher in group A than in group B. Logistic regression analyses showed that stone size was the only factor significantly associated with spontaneous passage of CBD stones. Conclusions CBD stones less than 0.33 cm in size may be self-expelled through the papilla.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Factors related to the spontaneous passage of common bile duct stones through the papilla: a single-center retrospective cohort study

et al. 2021

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“…15 False positive rates have been reported in 2016, at 31.5% for abnormal IOC with a normal ERCP. 16 In the current study, though not all surgeons perform IOC at our center, they also will employ additional techniques for patients with a positive IOC, including glucagon injection, balloon clearance devices, and "aggressive" high-pressure flushing. The intention of this study was not to analyze the particular techniques employed during CCY with IOC.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, a systematic review of eight IOC clinical trials totaling 1,715 patients found no benefit in preventing retained bile duct stones [ 15 ]. False positive rates have been reported in 2016, at 31.5% for abnormal IOC with a normal ERCP [ 16 ]. In the current study, though not all surgeons perform IOC at our center, they also will employ additional techniques for patients with a positive IOC, including glucagon injection, balloon clearance devices, and “aggressive” high-pressure flushing.…”

Section: Discussionmentioning

confidence: 99%

Increased Risk of Pancreatitis after Endoscopic Retrograde Cholangiopancreatography Following a Positive Intraoperative Cholangiogram: A Single-Center Experience

et al. 2021

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Background/Aims: To determine if patients with a positive intraoperative cholangiogram (IOC) who undergo a subsequent endoscopic retrograde cholangiopancreatography (ERCP) have an increased risk of post-ERCP pancreatitis (PEP) compared to those who undergo ERCP directly for suspected common bile duct stones. Methods: A retrospective case-control study was performed from 2010 to 2016. Cases included inpatients with a positive IOC at cholecystectomy who underwent subsequent ERCP. The control group included age-sex matched cohorts who underwent ERCP for choledocholithiasis. Multivariate logistic regression was used to assess the association between PEP and positive IOC, adjusting for matching variables and additional potential confounders. Results: Of the 116 patients that met the inclusion criteria, there were 91 women (78%) in each group. Nine patients (7.8%) developed PEP in the IOC group, compared to 3 patients in the control group (2.6%). The use of pancreatic duct stents and rectal indomethacin was similar in both groups. After adjusting for age, sex, total bilirubin levels, and any stent placement, patients with a positive IOC had a significantly increased risk of PEP (odds ratio, 4.79; 95% confidence interval, 1.05-21.89; p<0.05). Conclusions: In this single-center case-control study, there was a five-fold increased risk of PEP following a positive IOC compared to an age-sex matched cohort. Clin Endosc 2020 Jul 15.

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“…Bill and colleagues4 from St Louis, Missouri USA, have described a series of patients in whom the intra-operative cholangiogram (IOC) is deemed abnormal in the sense of poor passage of contrast, but in whom subsequent endoscopic retrograde cholangio-pancreatography (ERCP) shows no such abnormality. This poor correlation may relate to the difference between a filling defect and simply observing poor progress of contrast, and represents a previously undiscussed aspect of technique and interpretation.…”

Section: The Intra-operative Cholangiogram: When Is a Filling Defect mentioning

confidence: 99%

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Emmanuel¹

2016

Frontline Gastroenterol

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Evaluation of patients with abnormalities on intraoperative cholangiogram: time to abandon endoscopic retrograde cholangiopancreatography as the initial follow-up study

Cited by 7 publications

References 21 publications

Factors related to the spontaneous passage of common bile duct stones through the papilla: a single-center retrospective cohort study

Factors related to the spontaneous passage of common bile duct stones through the papilla: a single-center retrospective cohort study

Increased Risk of Pancreatitis after Endoscopic Retrograde Cholangiopancreatography Following a Positive Intraoperative Cholangiogram: A Single-Center Experience

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