Selective preoperative endoscopic retrograde cholangiography with sphincterotomy avoids bile duct exploration during laparoscopic cholecystectomy.

Welbourn, C. R. B.; Mehta, D.; Armstrong, Carrie; Gear, M. W. L.; Eyre‐Brook, I. A.

doi:10.1136/gut.37.4.576

Cited by 40 publications

(17 citation statements)

References 26 publications

(9 reference statements)

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“…The rate of pre-operative ERC (18%) was comparable to other studies (17-20%) although the proportion of patients presenting with jaundice was high at 15.5%. [7][8][9] The diagnostic yield of pre-operative ERC was 38%, which compared favourably with other reported series of 23-53%. [7][8][9] The stone rate is dependent on the selection criteria used, but is influenced by the interval between presentation and ERC as many stones pass spontaneously.…”

Section: Discussionmentioning

confidence: 60%

“…[7][8][9] The diagnostic yield of pre-operative ERC was 38%, which compared favourably with other reported series of 23-53%. [7][8][9] The stone rate is dependent on the selection criteria used, but is influenced by the interval between presentation and ERC as many stones pass spontaneously. In patients with obstructive jaundice or cholangitis, the yield of stones was high being at least 80% in patients with non-resolving jaundice or cholangitis and reducing sequentially as the jaundice resolved and the liver function tests returned to normal.…”

Section: Discussionmentioning

confidence: 60%

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Selective cholangiography in 600 patients undergoing cholecystectomy with 5-year follow-up for residual bile duct stones

Charfare

Cheslyn-Curtis²

2003

Annals of the Royal College of Surgeons of England

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A policy of selective pre-operative ERC is the most effective technique for identifying and removing bile duct stones and the incidence of symptomatic gallstones following laparoscopic cholecystectomy is very low. With an overall stone rate of 8%, routine peroperative cholangiography is unnecessary and, in a surgical unit providing an ERC service, laparoscopic exploration of the bile duct is not a technique required for the management of bile duct stones.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 60%

Selective cholangiography in 600 patients undergoing cholecystectomy with 5-year follow-up for residual bile duct stones

Charfare

Cheslyn-Curtis²

2003

Annals of the Royal College of Surgeons of England

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“…The quoted prevalence of CBDS in patients with symptomatic gallstones varies, but probably lies between 10 and 20% 17 – 21. However, in non-jaundiced patients with normal ducts on trans-abdominal ultrasound the prevalence of CBDS at the time of cholecystectomy is unlikely to exceed 5% 22…”

Section: 0 Natural History Of Cbdsmentioning

confidence: 99%

Guidelines on the management of common bile duct stones (CBDS)

Williams¹,

Green²,

Beckingham³

et al. 2008

Gut

508

374

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The last 30 years have seen major developments in the management of gallstone-related disease, which in the United States alone costs over 6 billion dollars per annum to treat. Endoscopic retrograde cholangiopancreatography (ERCP) has become a widely available and routine procedure, whilst open cholecystectomy has largely been replaced by a laparoscopic approach, which may or may not include laparoscopic exploration of the common bile duct (LCBDE). In addition, new imaging techniques such as magnetic resonance cholangiography (MR) and endoscopic ultrasound (EUS) offer the opportunity to accurately visualise the biliary system without instrumentation of the ducts. As a consequence clinicians are now faced with a number of potentially valid options for managing patients with suspected CBDS. It is with this in mind that the following guidelines have been written.

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“…Preoperative infusion cholangiography (PIC) suggested to be performed on a routine [43, 44] or selective [45] basis and ERC applied pre- [21, 22, 23, 24, 33] or postoperatively [23, 25], or both on a selective basis [46, 47, 48, 49, 50, 51, 52], have been included in the diagnostic and therapeutic armamentarium. However, in patients with acute cholecystitis neither PIC, nor preoperative ERC seem to be viable alternatives.…”

Section: Discussionmentioning

confidence: 99%

Factors Predictive of Bile Duct Stones in Patients with Acute Calculous Cholecystitis

Hammarström¹,

Ranstam²

1998

Dig Surg

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The objective of the study was to investigate the accuracy of using preoperative data for the prediction of bile duct calculi in patients operated on for acute cholecystitis. 279 consecutive patients underwent cholecystectomy with peroperative cholangiography for acute calculous cholecystitis in the Department of Surgery, Lund University Hospital, between 1985 and 1991. The correlation between 13 preoperative clinical and laboratory variables, and the incidence of bile duct calculi was studied. Among the 13 variables tested, serum bilirubin concentration and serum γ-glutamyltransferase activity were independent factors of predictive significance. These two factors were used for constructing an additive prognostic index for the presence of bile duct stones. Thus, three groups of patients could be identified having a 3, 7–9 or 59% risk of harboring bile duct stones, corresponding to a sensitivity of 61% and a specificity of 93% in predicting the presence of bile duct stones in the ‘high-risk’ group. Logistic regression analysis permits accurate preoperative identification of bile duct stones in patients with acute calculous cholecystitis.

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Selective preoperative endoscopic retrograde cholangiography with sphincterotomy avoids bile duct exploration during laparoscopic cholecystectomy.

Cited by 40 publications

References 26 publications

Selective cholangiography in 600 patients undergoing cholecystectomy with 5-year follow-up for residual bile duct stones

Selective cholangiography in 600 patients undergoing cholecystectomy with 5-year follow-up for residual bile duct stones

Guidelines on the management of common bile duct stones (CBDS)

Factors Predictive of Bile Duct Stones in Patients with Acute Calculous Cholecystitis

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