MRCP is Not a Cost-Effective Strategy in the Management of Silent Common Bile Duct Stones

Epelboym, Irene; Winner, Megan; Allendorf, John D.

doi:10.1007/s11605-013-2179-4

Cited by 42 publications

(21 citation statements)

References 41 publications

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“…15 Epelboym IL suggested that routine IOC is the preferred strategy in a cost-effectiveness analysis of the management of symptomatic cholelithiasis with asymptomatic choledocholithiasis. 16 MRCP was both more costly and less effective under all tested scenarios.…”

Section: Discussionmentioning

confidence: 94%

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: 94%

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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“…But the time component is a universal measure and in the world of shrinking hospital bed availability, is becoming one of our main outcomes measures. Epelboym and colleagues 24 found that MRCP and ERCP were not cost effective strategies for evaluating for suspicion of choledocholithiasis. Laparoscopic cholecystectomy þ IOC was the most cost effective strategy, followed by LC alone.…”

Section: Discussionmentioning

confidence: 99%

“…Their study was not done evaluating specific tools for cost utilization in patients who were admitted with a concern for choledocholithiasis. 24 However, the cost effectiveness of LC þ IOC is prompting us into a paradigm shift in our hospital. Our new protocol ( Fig.…”

Section: Discussionmentioning

confidence: 99%

Use of Magnetic Resonance Cholangiopancreatography in Clinical Practice: Not as Good as We Once Thought

Aydelotte

Ali

Huynh

et al. 2015

Journal of the American College of Surgeons

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“…Currently, the most important preoperative diagnostic tools are MRC and the traditional ultrasound [31][32][33][34][35] . Alternatively, the policy of routine MRC was not found to be cost-effective in patients without symptoms or suspicion of CBDS, whereas IOC during LC was the best strategy [36] . Interestingly, some authors reported [37] the routine use of IOC during LC, even after MRC and successful preoperative ERCP, to detect residual CBDS.…”

Section: Stonesmentioning

confidence: 99%

Modern approach to cholecysto-choledocholithiasis

Bencini¹

2014

WJGE

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Gallstones and common bile duct calculi are found to be associated in 8%-20% of patients, leading to possible life-threatening complications, such as acute biliary pancreatitis, jaundice and cholangitis. The gold standard of care for gallbladder calculi and isolated common bile duct stones is represented by laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography, respectively, while a debate still exists regarding how to treat the two diseases at the same time. Many therapeutic options are also available when the two conditions are associated, including many different types of treatment, which local professionals often administer. The need to limit maximum discomfort and risks for the patients, combined with the economic pressure of reducing costs and utilizing resources, favors single-step procedures. However, a multitude of data fail to strongly demonstrate the superiority of any technique (including a two or multi-step approach), while rigorous clinical trials that include so many different types of treatment are still lacking, and it is most likely unrealistic to conduct them in the future. Therefore, the choice of the best management is often led by the local presence of professional expertise and resources, rather than by a real superiority of one strategy over another.

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MRCP is Not a Cost-Effective Strategy in the Management of Silent Common Bile Duct Stones

Abstract: LC with routine IOC is the preferred strategy in a cost-effectiveness analysis of the management of symptomatic cholelithiasis with asymptomatic choledocholithiasis. MRCP was both more costly and less effective under all tested scenarios.

Cited by 42 publications

References 41 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

Use of Magnetic Resonance Cholangiopancreatography in Clinical Practice: Not as Good as We Once Thought

Modern approach to cholecysto-choledocholithiasis

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