825 Imaging in Suspected Gallstone Patients: Are We Optimising Resources?

Abstract

Abstract Aim Suspected biliary pathology necessitates imaging to assess for gallstones. Ultrasound is gold-standard but often limited by bowel gas/body habitus. MRCP has become popular due to superior ability to detect CBD stones. CT is often used with concerns of a wider differential diagnosis. This study aimed to explore the diagnostic journey of suspected gallstone patients, and whether increased imaging furthered patients’ management. Method This study used retrospective data collection of 2 months' referrals, October 1st-November 30th 2022 (inclusive), to the QEQM General Surgery team with suspected gallstones. This yielded 76 patients, for which PACS was reviewed to collate imaging performed. Results 28 patients received 1 scan type (37%) and 41 received 2 types (54%). 7 patients received all 3 of CT, US and MRCP (9%); 100% of these gained new information ranging from ductal stones/dilated CBD, to choledochal cysts. 63%with 2+ scan types obtained new information. An additional 15% of patients with 2+ scan types had the absence of CBD stones confirmed on MRCP, where US couldn't comment. 16 patients (33%) had an US/CT that could not confidently comment on CBD dilation. Conclusions Most patients had two or more scans, often CT/US followed by US/MRCP respectively, which typically expanded the clinical picture. Multi-modal imaging certainly proves useful, eradicating the individual limitations of each type as shown in this study. MRCP as first-line would prevent multiple scans for one patient but is much more limited in availability. US therefore continues to have significant value in detecting pathology in practice.