Randomised clinical trial: MRCP-first vs. ERCP-first approach in patients with suspected biliary obstruction due to bile duct stones

Bhat, Mamatha; Romagnuolo, Joseph; Silveira, Eduardo; Reinhold, Caroline; Valois, Eric; Martel, Myriam; Barkun, Jeffrey; Barkun, Alan N.

doi:10.1111/apt.12481

Cited by 23 publications

(21 citation statements)

References 30 publications

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“…Since its introduction to the clinical practice at the end of the 20 th century, MRCP has significantly been improved and now is a technique comparable with ERCP [6]. There are several reasons why MRCP has become more popular.…”

Section: Discussionmentioning

confidence: 99%

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Unusual Use of Gd-EOB-DTPA in MRCP in Order to Reveal the Source of Bile Leakage in a Patient with Neuroendocrine Tumor – Case Report

et al. 2016

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SummaryBackgroundMRCP is the method of choice in diagnosing pathologies of the biliary system. One of them is bile fistulae. They are uncommon but tend to cause many diagnostic problems. The possible way to improve MRCP is using it with intravenous injection of hepatobiliary-specific contrast agents. As it is eliminated via the hepatobiliary system, it can be visualized in the bile ducts and may help to reveal disorders undetected by a standard MRCP.Case ReportWe report a case of a 36-year-old woman with leakage in the biliary system which led to creation of a subcutaneous bile reservoir. By means of a regular MRCP protocol it was impossible to reveal any disorders of the biliary system and thus a decision to inject Gd-EOB-DTPA was taken. As a result, a fistula with its opening in the fundus of the gall bladder was revealed. Patient was qualified for treatment with somatostatin analogues in order to stop bile secretion.ConclusionsThe Gd-EOB-DTPA in combination with regular T2-weighted MRCP may be helpful in detecting anomalies of the biliary system. Although a high price of the procedure restricts its accessibility, such advantages as lower risk of complications, lower costs of hospitalization, and less traumatic nature make it a technique that may take precedence over ERCP in ambiguous cases.

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Section: Discussionmentioning

confidence: 99%

“…Another advantage over ERCP is the possibility of adding 3D imaging and imaging in different additional sequences. Not surprisingly, many studies proved that MRCP is equally or in some cases more effective than ERCP [6]. …”

Section: Discussionmentioning

confidence: 99%

Unusual Use of Gd-EOB-DTPA in MRCP in Order to Reveal the Source of Bile Leakage in a Patient with Neuroendocrine Tumor – Case Report

et al. 2016

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“…Столыпина в пери-од с октября 2013 г. по октябрь 2015 г. Объек-том исследования являлись беспородные собаки массой тела 12±1,5 кг в возрасте около 21±3 ме-сяцев. Оперативные вмешательства выполня-лись с соблюдением правил асептики и анти-септики согласно правилам «Европейской кон-венции о защите позвоночных животных, кото-рые используются для экспериментальных и научных целей» [4]. Экспериментальные жи-вотные были разделены на 2 группы.…”

Section: материалы и методыunclassified

Rentgenofunctional Evaluation of the Spine With Different Methods of Posterior Fixation in the Experiment

Кривошеин¹,

Ignatyev²,

Dochilova³

et al. 2016

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ель исследования. Рентгенологически сопоставить динамические свойства позвоночно-двигательного сегмента (ПДС) с различными способами задней фиксации в эксперименте. Материалы и методы. Объектом исследования являлись беспородные собаки массой тела 12±1,5 кг в возрасте около 21±3 месяцев. Экспериментальные животные были разделены на 2 группы. Животным I группы (n=5) проводилась транспедикуляр-ная фиксация позвоночника с использованием ригидных стержней. Животным II груп-пы (n=5) выполнялась транспедикулярная фиксация позвоночника с использованием динамических стержней из нитинола.Результаты. Объем движений в исследуемом сегменте до операции при функ-циональном исследовании в обеих группах составлял 18±1,2 градусов. В группе I на 24 месяце ригидной фиксацией ПДС после оперативного вмешательства объем движений составил 0±0,03 градуса. При анализе динамики рентгенограмм оперированного ПДС при ригидной фиксации объем движений отсутствовал. В группе II с динамической (нитинольной) фиксацией у всех животных присутствовали движения в ПДС и были в среднем 15±1,3 градусов, что составило 78,9% от исходного.Выводы. Динамическая транспедикулярная фиксация (нитинолом) по своим характеристикам позволяет более физиологично распределить динамическую нагрузку, сохраняет объём движений и снижает нагрузку на опорные элементы.Ключевые слова: позвоночно-двигательный сегмент, нитинол, динамическая фиксация, ригидная фиксация. urpose. To compare radiographically the dynamic properties of the vertebral-motor segment (VMS) with different methods of posterior fixation in the experiment. Materials and methods. The object of research was outbred dogs weighing 12±1.5 kg at the age of about 21±3 months. Experimental animals were divided into 2 groups. Animals of group I (n=5) underwent transpedicular fixation of the spine using rigid bolts. Transpedicular fixation of the spine with dynamic nitinol bolts was performed in animals of the II group (n=5).Results. During the functional study in both groups the range of motions in the test segment prior to surgery was 18±1.2 degree. After the surgery in group I the range of motion at 24 month of rigid VMS fixation was 0±0.03 degrees. During the analysis of the dynamic radiographs of the operated VMS within rigid fixation the motions were absent. In group II with dynamic (nitinol) fixation there were VMS movements in all animals at the average rate of 15±1.3 ° C, which was 78.9% of the initial.Conclusions. Dynamic transpedicular (nitinol) fixation according to its characteris-Ц P ОРИГИНАЛЬНАЯ СТАТЬЯ

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“…The original surgeon is likely to feel culpable for declaring complete recovery and may suffer a loss of rapport with the patient. Other issues include the medical expenditure associated with the diagnosis and treatment of retained CBD stones, the risk of complications associated with endoscopic retrograde cholangiopancreatography (ERCP), and increased patient distress [12]. …”

Section: Introductionmentioning

confidence: 99%

Prevalence and characteristics of clinically significant retained common bile duct stones after laparoscopic cholecystectomy for symptomatic cholelithiasis

et al. 2016

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PurposeTo investigate the prevalence and clinical features of retained symptomatic common bile duct (CBD) stone detected after laparoscopic cholecystectomy (LC) in patients without preoperative evidence of CBD or intrahepatic duct stones.MethodsOf 2,111 patients who underwent cholecystectomy between September 2007 and December 2014 at Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 1,467 underwent laparoscopic cholecystectomy for symptomatic gallbladder stones and their medical records were analyzed. We reviewed the clinical data of patients who underwent postoperative endoscopic retrograde cholangiopancreatography (ERCP) for clinically significant CBD stones (i.e., symptomatic stones requiring therapeutic intervention).ResultsOverall, 27 of 1,467 patients (1.84%) underwent postoperative ERCP after LC because of clinical evidence of retained CBD stones. The median time from LC to ERCP was 152 days (range, 60–1,015 days). Nine patients had ERCP-related complications. The median hospital stay for ERCP was 6 days.ConclusionThe prevalence of clinically significant retained CBD stone after LC for symptomatic cholelithiasis was 1.84% and the time from LC to clinical presentation ranged from 2 months to 2 years 9 months. Therefore, biliary surgeons should inform patients that retained CBD stone may be detected several years after LC for simple gallbladder stones.

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Randomised clinical trial: MRCP-first vs. ERCP-first approach in patients with suspected biliary obstruction due to bile duct stones

Abstract: SUMMARY BackgroundThe preferred initial investigation with either magnetic resonance (MRCP) or endoscopic retrograde cholangiopancreatography (ERCP) in patients with suspected biliary obstruction remains controversial in many clinical settings.

Cited by 23 publications

References 30 publications

Unusual Use of Gd-EOB-DTPA in MRCP in Order to Reveal the Source of Bile Leakage in a Patient with Neuroendocrine Tumor – Case Report

Unusual Use of Gd-EOB-DTPA in MRCP in Order to Reveal the Source of Bile Leakage in a Patient with Neuroendocrine Tumor – Case Report

Rentgenofunctional Evaluation of the Spine With Different Methods of Posterior Fixation in the Experiment

Prevalence and characteristics of clinically significant retained common bile duct stones after laparoscopic cholecystectomy for symptomatic cholelithiasis

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