Prediction of Which Patients with an Abnormal Intraoperative Cholangiogram Will Have a Confirmed Stone at ERCP

Abstract

Approximately one-half of patients with an abnormal IOC have a normal postoperative ERCP. None of the parameters evaluated in this retrospective study helped identify patients who merit further evaluation by ERCP. The argument could be made that in patients with an abnormal IOC, less invasive methods such as endoscopic ultrasound or magnetic resonance cholangiopancreatography could be used postoperatively if symptoms arise to assess for possible retained stone.

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

“…Despite the almost universal adoption of ERCP as a follow-up study to abnormalities identified on IOC, the optimal evaluation of patients with abnormal IOC findings is incompletely defined. Similar to the present study, Spinn et al 8 and Varadarajulu et al 5 have found that a sizable minority of patients who undergo ERCP for follow-up of abnormalities on IOC have no biliary pathology identified on cholangiogram or balloon sweep. Indeed, in a recent review of randomised trials evaluating the use of IOC during LC, Ford et al found that while the sensitivity and negative predictive value of IOC for choledocholithiasis was excellent (>96%), the positive predictive value of IOC was at best fair, at 56% 16.…”

“…In a prospective study, Varadarajulu et al 5 found that LFT abnormalities immediately prior to ERCP were associated with finding stones on ERCP. However, a subsequent study by Spinn et al 8 failed to identify any factors, including LFTs, as predictors of identifying choledocholithiasis at the time of ERCP. We did not observe an association between LFT abnormalities and finding of retained stone.…”

“…While ERCP is considered to be a safe and effective method of treating CBDS, ERCP is an invasive procedure, associated with a complication rate of up to 11% even in experienced hands 7. Moreover, recent studies have indicated that IOC may carry a false positive rate of 30–67%; thus, the question of whether ERCP is the most appropriate next step for patients with abnormalities on IOC has been raised 5 8…”

Major biliary complications in 2,714 cases of laparoscopic cholecystectomy without intraoperative cholangiography: a multicenter retrospective study

“…On the other hand, authors who adopt the selective IOC policy state that only one third of asymptomatic CBD stones need intervention [33,34]. Furthermore, of the so-called ''positive'' IOC for stones, only 50-65% of cases are proved to truly have stones [35,36]. Additionally, although IOC is mandatory for LCBDE, this procedure is performed only in some specialized centers where the necessary equipment and experience are available.…”

Laparoscopic Intraoperative Cholangiography Interpretation by Surgeons versus Radiologists, A Comparative Study and Review of 200 Cholangiographies

“…Postoperative ERCP is not a suitable gold standard for calculating false positives and negatives; it was only used in a small number, and stones may have appeared in, or disappeared from, the CBD in the interval since surgery. The argument could be made that in patients with an abnormal IOC less invasive methods such as endoscopic ultrasound or magnetic resonance cholangiopancreatography could be used postoperatively if symptoms arise to assess for possible retained stone [14]. The difference in LIOC interpretation between both groups did not affect the clinical course and outcome of the patients in our study because in our center the referral for postoperative ERCP depends on many factors besides the abnormal LIOC: persistent or increasing liver enzymes, abnormal postoperative ultrasonography, or MRCP.…”