Abstract
Background and objectives: Opinions differ regarding the optimal diagnostic methods for patients with suspected choledocholithiasis. The aim of this study was to assess the diagnostic accuracy of laparoscopic ultrasonography (LUS) and compare it to pre-operative magnetic resonance cholangio-pancreatography (MRCP); Materials and Methods: In all patients with suspected choledocholithiasis LUS was performed during laparoscopic cholecystectomy to evaluate biliary stones. According to availability, part of the patients had pre-operative MRCP. Data for diagnostic accuracy and main outcomes were collected prospectively and analyzed retrospectively; Results: Choledocholithiasis was detected in 178 of 297 patients by LUS (59.93%) and in 39 of 87 patients by MRCP (44.8%), p = 0.041. LUS yielded a sensitivity of 99.4%, a specificity of 94.3%, a positive predictive value of 96.1% and a negative predictive value of 99.1%. However, pre-operative MRCP had a sensitivity of 61.7%, a specificity of 92.3%, a positive predictive value of 94.9% and a negative predictive value of 51.1%. Moreover, of the 47 patients with no choledocholithiasis by MRCP, in 23 cases it was later detected by LUS (a false negative MRCP finding—38.3%), p < 0.001. Median duration of hospitalization was significantly shorter in patients evaluated without pre-operative MRCP—8 days (interquartile range – IQR 11–6) vs. 11 days (IQR 14–9), p = 0.001; Conclusions: LUS may reduce the role of pre-operative MRCP and can become a rational alternative to MRCP as a primary imaging technique for the detection of choledocholithiasis.
Highlights
Reported incidence of the common bile duct (CBD) stones varies between 8–20% in patients with gallstone disease [1]
magnetic resonance cholangio-pancreatography (MRCP) is still recommended as the method of choice at the pre-operative stage [3] followed by therapeutic endoscopic retrograde cholangio-pancreatography (ERCP) in the case of biliary stones as a first step and surgery afterward as a second step
MRCP may be less available in high patient flow hospitals, and it has a lower diagnostic accuracy if stones in the bile duct are smaller than 5 mm, especially in the case of biliary pancreatitis
Summary
Reported incidence of the common bile duct (CBD) stones varies between 8–20% in patients with gallstone disease [1]. MRCP is still recommended as the method of choice at the pre-operative stage [3] followed by therapeutic endoscopic retrograde cholangio-pancreatography (ERCP) in the case of biliary stones as a first step and surgery afterward as a second step. MRCP may be less available in high patient flow hospitals, and it has a lower diagnostic accuracy if stones in the bile duct are smaller than 5 mm, especially in the case of biliary pancreatitis. The aim of this study was to assess the diagnostic accuracy of laparoscopic ultrasonography (LUS) and compare it to pre-operative magnetic resonance cholangio-pancreatography (MRCP); Materials and Methods: In all patients with suspected choledocholithiasis LUS was performed during laparoscopic cholecystectomy to evaluate biliary stones. Pre-operative MRCP had a sensitivity of 61.7%, a specificity of 92.3%, a positive predictive value of 94.9% and a negative predictive value of 51.1%.
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