S1465: Identifying Patients Most Likely to Have a Common Bile Duct Stone At ERCP After an Abnormal Intraoperative Cholangiogram

Vadlamudi, Raja; Conway, Jason; Kundu, Sarba; Mishra, Girish; Baillie, John; Evans, John A.

doi:10.1016/j.gie.2010.03.239

Cited by 4 publications

(12 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Moreover, patients may have false-positive filling defects present, causing unnecessary CBD exploration or ERCP [13]. In addition, selective IOC is advocated in the presence of jaundice, pancreatitis, deranged LFTs, ultrasound evidence of a dilated CBD (>6 mm) or uncertain intraoperative biliary anatomy [6].…”

Section: Discussionmentioning

confidence: 99%

Outcomes From Routine Use of Intraoperative Cholangiogram in Laparoscopic Cholecystectomy: Factors Predicting Benefit From Selective Cholangiography

Akingboye

Mahmood

Ahmed

et al. 2021

Cureus

View full text Add to dashboard Cite

Background and objective Laparoscopic cholecystectomy is used for the treatment of symptomatic gallstones. Intraoperative cholangiogram (IOC) is used to diagnose common bile duct (CBD) stones. There is controversy surrounding routine vs selective use of IOC based on clinical, biochemical and ultrasound criteria. The aim of this study was to evaluate the outcomes from routine IOC and its utility in laparoscopic cholecystectomy. Materials and methods This was a UK-based single-centre retrospective study evaluating the outcomes from IOC for all laparoscopic cholecystectomies performed between May 2014 and February 2020. All adult patients undergoing elective, semi-elective or emergency operations were included. Demographics, biochemistry as well as radiological and endoscopic investigations were analysed. IOC was performed using a standardised technique and was interpreted by a single surgeon. Results A total of 744 out of 804 patients underwent IOC. The median age of the cohort was 51 years (SD: ±17.5); there were 468 females (62.9%) and 276 males (37.1%). Filling defects were identified in 43/744 (5.8%) patients, with 23/43 having stone extraction via endoscopic retrograde cholangiopancreatography (ERCP). Logistic regression analysis identified alkaline phosphatase (ALP) as a predictor of filling defects in IOC (OR: 1.003; 95% CI: 1.001-1.005, p=0.015). Conclusion Based on our findings, the routine use of IOC during laparoscopic cholecystectomy is safe and effective. Preoperative clinical, radiological and biochemical parameters apart from ALP have a limited role in predicting the diagnostic yield of IOC.

show abstract

Section: Discussionmentioning

confidence: 99%

Outcomes From Routine Use of Intraoperative Cholangiogram in Laparoscopic Cholecystectomy: Factors Predicting Benefit From Selective Cholangiography

Akingboye

Mahmood

Ahmed

et al. 2021

Cureus

View full text Add to dashboard Cite

show abstract

“…CBD stones are present in 10–15% of patients undergoing elective cholecystectomy . IOC is widely used to delineate biliary anatomy as well as to evaluate the presence of choledocholithiasis, with the intention of preventing serious complications including gallstone pancreatitis, acute cholangitis and biliary obstruction.…”

Section: Discussionmentioning

confidence: 99%

“…Evaluation of CBD stones during laparoscopic cholecystectomy CBD stones are present in 10-15% of patients undergoing elective cholecystectomy. [1][2][3] IOC is widely used to delineate biliary anatomy as well as to evaluate the presence of choledocholithiasis, with the intention of preventing serious complications including gallstone pancreatitis, acute cholangitis and biliary obstruction. However, the true incidence of complications due to retained stones remains unknown.…”

Section: Discussionmentioning

confidence: 99%

“…However, experience with IOC over the past two decades has demonstrated that it has several limitations, such as the prolonged operative time, the occurrence of complications and added costs. More importantly, some studies have suggested that it has a false‐positive rate of up to 50% for detecting stones . The clinical consequence of this current practice is that many unnecessary ERCP have been performed, with their own inherent risks including bleeding, perforation, pancreatitis and the complications of sedation …”

Section: Introductionmentioning

confidence: 99%

“…More importantly, some studies have suggested that it has a falsepositive rate of up to 50% for detecting stones. 2 The clinical consequence of this current practice is that many unnecessary ERCP have been performed, with their own inherent risks including bleeding, perforation, pancreatitis and the complications of sedation. 3 Thus, it is imperative to identify clinical factors that may assist in determining which patients with a positive IOC are at an increased risk for harboring stones.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Can clinical factors predict the need for intervention after a positive intraoperative cholangiogram?

Kaif

Agrawal

Sreenarasimhaiah

2017

J of Digest Diseases

View full text Add to dashboard Cite

show abstract

A Prospective Blinded Study Evaluating the Role of Endoscopic Ultrasound before Endoscopic Retrograde Cholangiopancreatography in the Setting of “Positive” Intraoperative Cholangiogram during Cholecystectomy

Luthra

Aggarwal

Mishra

et al. 2016

The American Surgeon

Self Cite

View full text Add to dashboard Cite

During laparoscopic cholecystectomy, intraoperative cholangiography (IOC) is used to identify common bile duct (CBD) stones. In patients whose IOC is suspicious for stones, endoscopic retrograde cholangiopancreatography (ERCP) is the modality of choice for stone removal. However, IOC has a false positive rate of 30 to 60 per cent, and ERCP adverse events may occur in 11 per cent of patients. Endoscopic ultrasound (EUS) may serve as a noninvasive means of diagnosing suspected CBD stones. This study sought to assess the role of EUS in predicting the likelihood of choledocholithiasis at ERCP in patients found to have a positive IOC. This was a prospective blinded study of EUS before ERCP in patients with a positive IOC. Recruited subjects who underwent cholecystectomy and had an IOC with suspicion for obstruction were referred for ERCP within one month of their procedure. In patients with a positive IOC, EUS had a positive predictive value of 95 per cent in detecting choledocholithiasis. IOC with single or multiple filling defects more often correlated to the presence of CBD stones. At ERCP, choledocholithiasis was present in 65 per cent of patients who had an IOC suspicious for CBD stones. EUS should be used as a noninvasive method to correctly identify retained CBD stones in low-to-moderate risk patients with a positive IOC.

show abstract

S1465: Identifying Patients Most Likely to Have a Common Bile Duct Stone At ERCP After an Abnormal Intraoperative Cholangiogram

Cited by 4 publications

References 0 publications

Outcomes From Routine Use of Intraoperative Cholangiogram in Laparoscopic Cholecystectomy: Factors Predicting Benefit From Selective Cholangiography

Outcomes From Routine Use of Intraoperative Cholangiogram in Laparoscopic Cholecystectomy: Factors Predicting Benefit From Selective Cholangiography

Can clinical factors predict the need for intervention after a positive intraoperative cholangiogram?

A Prospective Blinded Study Evaluating the Role of Endoscopic Ultrasound before Endoscopic Retrograde Cholangiopancreatography in the Setting of “Positive” Intraoperative Cholangiogram during Cholecystectomy

Contact Info

Product

Resources

About