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Laparoscopic Ultrasonography Versus Magnetic Resonance Cholangiopancreatography in Laparoscopic Surgery for Symptomatic Cholelithiasis and Suspected Common Bile Duct Stones

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

There continues to be controversy regarding the optimal screening modality in patients with symptomatic cholelithiasis and suspected common bile duct (CBD) stones. The aim of this study was to assess the diagnostic accuracy of laparoscopic ultrasonography (LUS) compared to magnetic resonance cholangiopancreatography (MRCP).

Methods

Both LUS and MRCP were performed to evaluate the CBD stones and biliary anatomy in 200 patients undergoing laparoscopic surgery. Pre-, intra-, and postoperative data were collected prospectively and reviewed retrospectively.

Results

Coexisting CBD stones were identified in 64 of 200 (32%) patients by surgical exploration or postoperative ERCP. For the detection of CBD stones, LUS yielded a positive predictive value of 100%, a negative predictive value of 99.3%, a sensitivity of 98.4%, and a specificity of 100%. Preoperative MRCP had a positive predictive value of 87.9%, a negative predictive value of 95.5%, a sensitivity of 90.6%, and a specificity of 94.1%. The non-random concordance between MRCP and LUS was considered to be excellent with a kappa coefficient of 0.92 (p < 0.01).

Conclusions

LUS can reduce the need for MRCP examination and can become the primary imaging method for the evaluation of CBD stones in laparoscopic surgery.

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References

  1. Kharbutli B, Velanovich V. Management of preoperatively suspected choledocholithiasis: a decision analysis. J Gastrointest Surg. 2008. 12(11): 1973–80.

    Article  PubMed  Google Scholar 

  2. Brown LM, Rogers SJ, Cello JP, Brasel KJ, Inadomi JM. Cost-effective treatment of patients with symptomatic cholelithiasis and possible common bile duct stones. J Am Coll Surg. 2011. 212(6): 1049–1060.e1–7.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Lacaine F, Corlette MB, Bismuth H. Preoperative evaluation of the risk of common bile duct stones. Arch Surg. 1980. 115(9): 1114–6.

    Article  CAS  PubMed  Google Scholar 

  4. Houdart R, Perniceni T, Darne B, Salmeron M, Simon JF. Predicting common bile duct lithiasis: determination and prospective validation of a model predicting low risk. Am J Surg. 1995. 170(1): 38–43.

    Article  CAS  PubMed  Google Scholar 

  5. Neuhaus H, Feussner H, Ungeheuer A, Hoffmann W, Siewert JR, Classen M. Prospective evaluation of the use of endoscopic retrograde cholangiography prior to laparoscopic cholecystectomy. Endoscopy. 1992. 24(9): 745–9.

    Article  CAS  PubMed  Google Scholar 

  6. Collins C, Maguire D, Ireland A, Fitzgerald E, O'Sullivan GC. A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy: natural history of choledocholithiasis revisited. Ann Surg. 2004. 239(1): 28–33.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hamouda AH, Goh W, Mahmud S, Khan M, Nassar AH. Intraoperative cholangiography facilitates simple transcystic clearance of ductal stones in units without expertise for laparoscopic bile duct surgery. Surg Endosc. 2007. 21(6): 955–9.

    Article  CAS  PubMed  Google Scholar 

  8. Alponat A, Kum CK, Rajnakova A, Koh BC, Goh PM. Predictive factors for synchronous common bile duct stones in patients with cholelithiasis. Surg Endosc. 1997. 11(9): 928–32.

    Article  CAS  PubMed  Google Scholar 

  9. Abboud PA, Malet PF, Berlin JA, et al. Predictors of common bile duct stones prior to cholecystectomy: a meta-analysis. Gastrointest Endosc. 1996. 44(4): 450–5.

    Article  CAS  PubMed  Google Scholar 

  10. Williams EJ, Green J, Beckingham I, Parks R, Martin D, Lombard M. Guidelines on the management of common bile duct stones (CBDS). Gut. 2008. 57(7): 1004–21.

    Article  CAS  PubMed  Google Scholar 

  11. Maple JT, Ben-Menachem T, Anderson MA, et al. The role of endoscopy in the evaluation of suspected choledocholithiasis. Gastrointest Endosc. 2010. 71(1): 1–9.

    Article  PubMed  Google Scholar 

  12. Shaaban H, Welch A, Rao S. Laparoscopic ultrasound for the diagnosis of choledocholithiasis: quick, safe, and effective. Surg Laparosc Endosc Percutan Tech. 2014. 24(3): 274–6.

    Article  PubMed  Google Scholar 

  13. Qiu Y, Yang Z, Li Z, Zhang W, Xue D. Is preoperative MRCP necessary for patients with gallstones? An analysis of the factors related to missed diagnosis of choledocholithiasis by preoperative ultrasound. BMC Gastroenterol. 2015. 15: 158.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Sun SX, Kulaylat AN, Hollenbeak CS, Soybel DI. Cost-effective Decisions in Detecting Silent Common Bile Duct Gallstones During Laparoscopic Cholecystectomy. Ann Surg. 2016. 263(6): 1164–72.

    Article  PubMed  Google Scholar 

  15. Onders RP, Hallowell PT. The era of ultrasonography during laparoscopic cholecystectomy. Am J Surg. 2005. 189(3): 348–51.

    Article  PubMed  Google Scholar 

  16. Isherwood J, Garcea G, Williams R, Metcalfe M, Dennison AR. Serology and ultrasound for diagnosis of choledocholithiasis. Ann R Coll Surg Engl. 2014. 96(3): 224–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Salminen P, Laine S, Gullichsen R. Severe and fatal complications after ERCP: analysis of 2555 procedures in a single experienced center. Surg Endosc. 2008. 22(9): 1965–70.

    Article  CAS  PubMed  Google Scholar 

  18. Vitte RL, Morfoisse JJ. Evaluation of endoscopic retrograde cholangiopancreatography procedures performed in general hospitals in France. Gastroenterol Clin Biol. 2007. 31(8–9 Pt 1): 740–9.

    Article  PubMed  Google Scholar 

  19. Williams EJ, Taylor S, Fairclough P, et al. Are we meeting the standards set for endoscopy? Results of a large-scale prospective survey of endoscopic retrograde cholangio-pancreatograph practice. Gut. 2007. 56(6): 821–9.

    Article  PubMed  Google Scholar 

  20. Snow LL, Weinstein LS, Hannon JK, Lane DR. Evaluation of operative cholangiography in 2043 patients undergoing laparoscopic cholecystectomy: a case for the selective operative cholangiogram. Surg Endosc. 2001. 15(1): 14–20.

    Article  CAS  PubMed  Google Scholar 

  21. Ragulin-Coyne E, Witkowski ER, Chau Z, et al. Is routine intraoperative cholangiogram necessary in the twenty-first century? A national view. J Gastrointest Surg. 2013. 17(3): 434–42.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Catheline JM, Turner R, Paries J. Laparoscopic ultrasonography is a complement to cholangiography for the detection of choledocholithiasis at laparoscopic cholecystectomy. Br J Surg. 2002. 89(10): 1235–9.

    Article  CAS  PubMed  Google Scholar 

  23. Millat B, Atger J, Deleuze A, et al. Laparoscopic treatment for choledocholithiasis: a prospective evaluation in 247 consecutive unselected patients. Hepatogastroenterology. 1997. 44(13): 28–34.

    CAS  PubMed  Google Scholar 

  24. Tranter SE, Thompson MH. Potential of laparoscopic ultrasonography as an alternative to operative cholangiography in the detection of bile duct stones. Br J Surg. 2001. 88(1): 65–9.

    Article  CAS  PubMed  Google Scholar 

  25. Sirinek KR, Schwesinger WH. Has intraoperative cholangiography during laparoscopic cholecystectomy become obsolete in the era of preoperative endoscopic retrograde and magnetic resonance cholangiopancreatography. J Am Coll Surg. 2015. 220(4): 522–8.

    Article  PubMed  Google Scholar 

  26. Tranter SE, Thompson MH. A prospective single-blinded controlled study comparing laparoscopic ultrasound of the common bile duct with operative cholangiography. Surg Endosc. 2003. 17(2): 216–9.

    Article  CAS  PubMed  Google Scholar 

  27. Boraschi P, Gigoni R, Braccini G, Lamacchia M, Rossi M, Falaschi F. Detection of common bile duct stones before laparoscopic cholecystectomy. Evaluation with MR cholangiography. Acta Radiol. 2002. 43(6): 593–8.

    Article  CAS  PubMed  Google Scholar 

  28. Tranter SE, Thompson MH. Spontaneous passage of bile duct stones: frequency of occurrence and relation to clinical presentation. Ann R Coll Surg Engl. 2003. 85(3): 174–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Birth M, Carroll BJ, Delinikolas K, Eichler M, Weiser H. Recognition of laparoscopic bile duct injuries by intraoperative ultrasonography. Surg Endosc. 1996. 10(8): 794–7.

    Article  CAS  PubMed  Google Scholar 

  30. Tomonaga T, Filipi CJ, Lowham A, Martinez T. Laparoscopic intracorporeal ultrasound cystic duct length measurement: a new technique to prevent common bile duct injuries. Surg Endosc. 1999. 13(2): 183–5.

    Article  CAS  PubMed  Google Scholar 

  31. Machi J, Oishi AJ, Uchida S, Furumoto NL, Oishi RH. Simple laparoscopic ultrasound technique for prevention of bile duct injuries. J Laparoendosc Adv Surg Tech A. 2000. 10(3): 165–8.

    Article  CAS  PubMed  Google Scholar 

  32. Lee SP, Maher K, Nicholls JF. Origin and fate of biliary sludge. Gastroenterology. 1988. 94(1): 170–6.

    Article  CAS  PubMed  Google Scholar 

  33. Keizman D, Ish-Shalom M, Konikoff FM. The clinical significance of bile duct sludge: is it different from bile duct stones. Surg Endosc. 2007. 21(5): 769–73.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Hepatobiliary Surgery, Chinese PLA General Hospital, Bei**g, 100853, China

    Ying Luo, Tao Yang, Qiang Yu & Yu Zhang

Authors
  1. Ying Luo
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  2. Tao Yang
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  3. Qiang Yu
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  4. Yu Zhang
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Contributions

Ying Luo proposed and performed the study and wrote the paper. Tao Yang performed the study and revised the paper, Qiang Yu performed the study and collected data, and Yu Zhang performed the study. All the authors contributed to the design and interpretation of the study and to further drafts. Ying Luo is the guarantor.

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Correspondence to Ying Luo.

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Ethical Approval

The study was conducted according to the ethical guidelines of the Helsinki Declaration and was approved by the Ethics Committee of Chinese PLA General Hospital, Bei**g, China.

Competing Interest

The authors declare that they have no conflict of interest.

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Luo, Y., Yang, T., Yu, Q. et al. Laparoscopic Ultrasonography Versus Magnetic Resonance Cholangiopancreatography in Laparoscopic Surgery for Symptomatic Cholelithiasis and Suspected Common Bile Duct Stones. J Gastrointest Surg 23, 1143–1147 (2019). https://doi.org/10.1007/s11605-018-3949-9

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  • DOI: https://doi.org/10.1007/s11605-018-3949-9

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