Is Routine MRCP Needed in Symptomatic Gallstone Disease? - A Single Center Experience

Abstract

Objectives: To assess the role of magnetic resonance cholangiopancreatography (MRCP) in the detection of choledocholithiasis in patients with symptomatic gallstone disease and to determine the anatomical variations of extra hepatic biliary tract and their relation to bile duct injury during laparoscopic cholecystectomy. Methods: This is a retrospective observational study of 80 patients from a prospectively maintained database from October 2017 to September 2019. On the basis of findings from Preoperative liver function test and Ultrasound abdomen, patients were divided into 3 groups as per ASGE guidelines for the risk of choledocholithiasis[high risk(n=14),medium risk(n=13),low/no risk(n=53)]. MRCP was performed in all patients routinely. Results: MRCP detected choledocholithiasis in 14 patients. 9 out of 14 patients had dilated CBD on Ultrasound and 7 had elevated ALP. Among 66 patients without CBD stone, ALP was elevated in 4 patients. Patients with MRCP detected stones were subjected to ERCP which was successful in 9 patients. From remaining 5 patients with unsuccessful ERCP, two patients underwent laparoscopic CBD exploration/T tube drainage, one patient underwent bilioenteric anastomosis, two patients with biliary pancreatitis were managed with laparoscopic cholecystectomy alone in view of passed out stone. MRCP diagnosed extrahepatic biliary tract variations in 15% cases(n=12). No patient suffered bile duct injury in this study. Conclusion: In view of high sensitivity to detect choledocholithiasis even in normal LFT and USG abdomen and to delineate extrahepatic biliary anatomy, we suggest routine MRCP in all cases of symptomatic gallstone disease to aid in preoperative management and prevention of bile duct injury.