Is preoperative MRCP necessary for patients with gallstones? An analysis of the factors related to missed diagnosis of choledocholithiasis by preoperative ultrasound

Qiu, Yan; Yang, Zhengpeng; Li, Zhituo; Zhang, Weihui; Xue, Dongbo

doi:10.1186/s12876-015-0392-1

Cited by 27 publications

(25 citation statements)

References 38 publications

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“…We analyzed patients with preoperative suspicion of choledocholithiasis rather than all patients undergoing cholecystectomy, as our aim was to test the clinical utility of guidelines in preoperative suspected choledocholithiasis. This might have changed diagnostic accuracy only slightly, as two previous studies have shown that CBD stone with normal LFT is rare and accounts for only 1.69 % -5.4 % of all cases [15,16].…”

Section: Discussionmentioning

confidence: 99%

Clinical utility of ESGE and ASGE guidelines for prediction of suspected choledocholithiasis in patients undergoing cholecystectomy

Jagtap

Tandan

et al. 2020

Endoscopy

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Background Recent guidelines from the European Society of Gastrointestinal Endoscopy (ESGE) and American Society for Gastrointestinal Endoscopy (ASGE) recommend risk stratification according to liver function test (LFT) and abdominal ultrasound in patients with suspected choledocholithiasis. We evaluated and validated the clinical utility of these new risk stratification criteria for choledocholithiasis. Methods We retrospectively analyzed prospectively maintained data of patients with suspected choledocholithiasis between January 2016 and December 2018 in patients undergoing cholecystectomy. Patients with common bile duct stricture, cirrhosis, and portal biliopathy were excluded. After LFT and ultrasound, all patients were stratified according to ESGE and ASGE criteria into high, intermediate, and low likelihood of choledocholithiasis. Results 1042 patients were analyzed. Using ESGE guidelines, 213 patients (20.4 %) met high likelihood criteria, 637 (61.1 %) met intermediate, and 192 (18.4 %) met low likelihood criteria. Using ASGE guidelines, 230 (22.1 %), 678 (65.1 %), and 134 (12.9 %) met high, intermediate, and low likelihood criteria, respectively. Specificity and positive predictive value (PPV) of ASGE high likelihood criteria were 96.87 % (95 % confidence interval [CI] 95.37 – 97.98) and 89.57 % (95 %CI 85.20 – 92.75) for choledocholithiasis compared with 98.96 % (95 %CI 97.95 – 99.55) and 96.24 % (95 %CI 92.76 – 98.09), respectively, for ESGE criteria. ASGE classified 17 (7.4 %) additional patients as high likelihood compared with ESGE, only one of whom had choledocholithiasis. ASGE classified 58 (8.6 %) additional patients as intermediate, none of whom had choledocholithiasis. Conclusion This study validates the clinical utility of new ESGE and ASGE criteria for predicting choledocholithiasis. ESGE risk stratification appears more specific than ASGE.

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Section: Discussionmentioning

confidence: 99%

Clinical utility of ESGE and ASGE guidelines for prediction of suspected choledocholithiasis in patients undergoing cholecystectomy

Jagtap

Tandan

et al. 2020

Endoscopy

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“…The risk of having CBDSs in spite of normal LFTs and ultrasonography has been adequately evaluated in two studies [35,36]. In a large study including 765 patients with ERCPproven CBDSs, 541 had previously documented LFTs and 29 (5.4 %) had normal LFTs.…”

Section: Initial Evaluationmentioning

confidence: 99%

“…Age more than 55 years and the presence of pain were independently associated with normal LFTs in patients with CBDSs [35]. A more recent retrospective study including 413 patients with gallstones who underwent ultrasonography and magnetic resonance cholangiopancreatography (MRCP) for suspected CBDSs showed that 109 /413 (26.3 %) had CBDSs revealed on the MRCP, but in 7 /109 (6.4 %) ultrasonography and LFTs (one or more of total bilirubin, ALP, AST, ALT, or GGT) were normal [36] (Table 2 s).…”

Section: Initial Evaluationmentioning

confidence: 99%

Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline

et al. 2019

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Main RecommendationsESGE recommends offering stone extraction to all patients with common bile duct stones, symptomatic or not, who are fit enough to tolerate the intervention.Strong recommendation, low quality evidence.ESGE recommends liver function tests and abdominal ultrasonography as the initial diagnostic steps for suspected common bile duct stones. Combining these tests defines the probability of having common bile duct stones.Strong recommendation, moderate quality evidence.ESGE recommends endoscopic ultrasonography or magnetic resonance cholangiopancreatography to diagnose common bile duct stones in patients with persistent clinical suspicion but insufficient evidence of stones on abdominal ultrasonography.Strong recommendation, moderate quality evidence.ESGE recommends the following timing for biliary drainage, preferably endoscopic, in patients with acute cholangitis, classified according to the 2018 revision of the Tokyo Guidelines:– severe, as soon as possible and within 12 hours for patients with septic shock– moderate, within 48 – 72 hours– mild, elective.Strong recommendation, low quality evidence.ESGE recommends endoscopic placement of a temporary biliary plastic stent in patients with irretrievable biliary stones that warrant biliary drainage.Strong recommendation, moderate quality of evidence.ESGE recommends limited sphincterotomy combined with endoscopic papillary large-balloon dilation as the first-line approach to remove difficult common bile duct stones. Strong recommendation, high quality evidence.ESGE recommends the use of cholangioscopy-assisted intraluminal lithotripsy (electrohydraulic or laser) as an effective and safe treatment of difficult bile duct stones.Strong recommendation, moderate quality evidence.ESGE recommends performing a laparoscopic cholecystectomy within 2 weeks from ERCP for patients treated for choledocholithiasis to reduce the conversion rate and the risk of recurrent biliary events. Strong recommendation, moderate quality evidence.

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“…The tested population did not reflect known malignancy, chronic pain, or painless jaundice. The prevalence of choledocholithiasis in the overall population for the base case was 27% (accounting for all manifestations of symptomatic gallstone disease, including cholecystitis and pancreatitis) (45,(53)(54)(55). In the base case of patients with known gallstones at presentation, 10% of patients had a biliary stricture, and 10% of strictures had a malignant etiology of obstruction (resulting in 1% risk of malignancy overall); these probabilities were varied in sensitivity analysis (39,40,56).…”

Section: Model Population and Treatment Of Diseasementioning

confidence: 99%

Risk-stratified versus Non–Risk-stratified Diagnostic Testing for Management of Suspected Acute Biliary Obstruction: Comparative Effectiveness, Costs, and the Role of MR Cholangiopancreatography

et al. 2017

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Purpose To analyze the cost-effectiveness of the American Society for Gastrointestinal Endoscopy (ASGE) risk stratification guidelines versus magnetic resonance (MR) cholangiopancreatography-based treatment of patients with possible choledocholithiasis. Materials and Methods A decision-analytic model was constructed to compare cost and effectiveness of three diagnostic strategies for gallstone disease with possible choledocholithiasis: noncontrast MR cholangiopancreatography, contrast material-enhanced MR imaging/MR cholangiopancreatography, and ASGE risk stratification guidelines for diagnostic evaluation recommending endoscopy (high risk), MR cholangiopancreatography (intermediate risk), or no test (low risk). Analysis was performed from a U.S. health system perspective over 1-year and lifetime horizons. The model accounted for benign and malignant causes of biliary obstruction and procedural complications. Cost information was based on Medicare reimbursements. Sensitivity analysis assessed the impact of parameter variability on model results. Results Noncontrast MR cholangiopancreatography was most cost-effective in 45-55-year-old patients (less than $100 000 per quality-adjusted life-year [QALY] gained), while contrast-enhanced MR imaging was favored in younger adults. Risk-stratified testing was less costly than MR cholangiopancreatography, with long-term savings of $1870 and $2068 versus noncontrast and contrast-enhanced MR cholangiopancreatography, respectively, but was also less effective (-0.1814, -0.1831 QALY, respectively). The lifetime incremental cost per QALY for noncontrast MR cholangiopancreatography was $10 311. Contrast-enhanced MR imaging was favored with pretest probabilities of biliary stricture or malignancy 0%-73% for patients aged 20-44 years. For patients older than 55 years, ASGE guidelines maximized QALYs at the lowest cost. Conclusion Although adults older than 55 years of age are optimally evaluated by using ASGE guidelines, younger patients suspected of having acute biliary obstruction likely benefit from MR cholangiopancreatography rather than risk-stratified diagnostic imaging because of improved detection of choledocholithiasis and alternative causes of biliary obstruction. RSNA, 2017 Online supplemental material is available for this article.

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Is preoperative MRCP necessary for patients with gallstones? An analysis of the factors related to missed diagnosis of choledocholithiasis by preoperative ultrasound

Cited by 27 publications

References 38 publications

Clinical utility of ESGE and ASGE guidelines for prediction of suspected choledocholithiasis in patients undergoing cholecystectomy

Clinical utility of ESGE and ASGE guidelines for prediction of suspected choledocholithiasis in patients undergoing cholecystectomy

Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline

Risk-stratified versus Non–Risk-stratified Diagnostic Testing for Management of Suspected Acute Biliary Obstruction: Comparative Effectiveness, Costs, and the Role of MR Cholangiopancreatography

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