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Langenbeck's Archives of Surgery

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01-11-2009 | Original Article

Is routine MR cholangiopancreatography (MRCP) justified prior to cholecystectomy?

Authors: C. A. Nebiker, S. A. Baierlein, S. Beck, M. von Flüe, C. Ackermann, R. Peterli

Published in: Langenbeck's Archives of Surgery | Issue 6/2009

Abstract

Purpose

We investigated routinely the bile ducts by magnetic resonance cholangiopancreaticography (MRCP) prior to cholecystectomy. The aim of this study was to analyze the rate of clinically inapparent common bile duct (CBD) stones, the predictive value of elevated liver enzymes for CBD stones, and the influence of the radiological results on the perioperative management.

Methods

In this prospective study, 465 patients were cholecystectomized within 18 months, mainly laparoscopically. Preoperative MRCP was performed in 454 patients.

Results

With MRCP screening, clinically silent CBD stones were found in 4%. Elevated liver enzymes have only a poor predictive value for the presence of CBD stones (positive predictive value, 21%; negative predictive value, 96%). Compared to the recent literature, the postoperative morbidity in this study was low (0 bile duct injury, 0.4% residual gallstones).

Conclusions

Although MRCP is diagnostically useful in the perioperative management in some cases, its routine use in the DRG-era may not be justified due to the costs.

Peng WK et al (2005) Role of liver function tests in predicting common bile duct stones in acute calculous cholecystitis. Br J Surg 92(10):1241–1247CrossRefPubMed

Wolnerhanssen BK et al (2005) [Twelve years of laparoscopic cholecystectomy]. Chirurg 76(3):263–269CrossRefPubMed

Peterli R et al (1998) [Postcholecystectomy complaints one year after laparoscopic cholecystectomy. Results of a prospective study of 253 patients]. Chirurg 69(1):55–60CrossRefPubMed

Peterli R et al (2000) Prevalence of postcholecystectomy symptoms: long-term outcome after open versus laparoscopic cholecystectomy. World J Surg 24(10):1232–1235CrossRefPubMed

Ke ZW et al (2003) Prospective evaluation of magnetic resonance cholangiography in patients with suspected common bile duct stones before laparoscopic cholecystectomy. Hepatobiliary Pancreat Dis Int 2(4):576–580PubMed

Mussack T et al (2002) [The value of magnetic resonance cholangiography for the expedient diagnosis of choledocholithiasis]. Dtsch Med Wochenschr 127(15):786–790CrossRefPubMed

Urban M et al (2002) Efficacy of diagnosis of mechanical cholestasis by magnetic resonance cholangiography. World J Surg 26(3):353–358CrossRefPubMed

Laokpessi A et al (2001) Value of magnetic resonance cholangiography in the preoperative diagnosis of common bile duct stones. Am J Gastroenterol 96(8):2354–2359CrossRefPubMed

Demartines N et al (2000) Evaluation of magnetic resonance cholangiography in the management of bile duct stones. Arch Surg 135(2):148–152CrossRefPubMed

10.

Liu TH et al (1999) The efficacy of magnetic resonance cholangiography for the evaluation of patients with suspected choledocholithiasis before laparoscopic cholecystectomy. Am J Surg 178(6):480–484CrossRefPubMed

11.

Dwerryhouse SJ, Brown E, Vipond MN (1998) Prospective evaluation of magnetic resonance cholangiography to detect common bile duct stones before laparoscopic cholecystectomy. Br J Surg 85(10):1364–1366CrossRefPubMed

12.

Hallal AH et al (2005) Magnetic resonance cholangiopancreatography accurately detects common bile duct stones in resolving gallstone pancreatitis. J Am Coll Surg 200(6):869–875CrossRefPubMed

13.

Boraschi P et al (2002) Detection of common bile duct stones before laparoscopic cholecystectomy. Evaluation with MR cholangiography. Acta Radiol 43(6):593–598CrossRefPubMed

14.

Diagnosis and treatment of common bile duct stones (CBDS) (1998) Results of a consensus development conference. Scientific Committee of the European Association for Endoscopic Surgery (E.A.E.S.). Surg Endosc 12(6):856–864CrossRef

15.

Koo KP, Traverso LW (1996) Do preoperative indicators predict the presence of common bile duct stones during laparoscopic cholecystectomy? Am J Surg 171(5):495–499CrossRefPubMed

16.

Pavone P et al (1997) MR cholangiography (MRC) in the evaluation of CBD stones before laparoscopic cholecystectomy. Surg Endosc 11(10):982–985CrossRefPubMed

17.

Alponat A et al (1997) Predictive factors for synchronous common bile duct stones in patients with cholelithiasis. Surg Endosc 11(9):928–932CrossRefPubMed

18.

Ausch C et al (2005) Improving the safety of laparoscopic cholecystectomy: the routine use of preoperative magnetic resonance cholangiography. Surg Endosc 19(4):574–580CrossRefPubMed

19.

Menezes N et al (2000) Prospective analysis of a scoring system to predict choledocholithiasis. Br J Surg 87(9):1176–1181CrossRefPubMed

20.

Jendresen MB et al (2002) Preoperative routine magnetic resonance cholangiopancreatography before laparoscopic cholecystectomy: a prospective study. Eur J Surg 168(12):690–694CrossRefPubMed

21.

Liu TH et al (2001) Patient evaluation and management with selective use of magnetic resonance cholangiography and endoscopic retrograde cholangiopancreatography before laparoscopic cholecystectomy. Ann Surg 234(1):33–40CrossRefPubMed

22.

Collins C et al (2004) A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy: natural history of choledocholithiasis revisited. Ann Surg 239(1):28–33CrossRefPubMed

23.

Bose SM et al (2001) Evaluation of the predictors of choledocholithiasis: comparative analysis of clinical, biochemical, radiological, radionuclear, and intraoperative parameters. Surg Today 31(2):117–122CrossRefPubMed

24.

Turner MA, Fulcher AS (2001) The cystic duct: normal anatomy and disease processes. Radiographics 21(1):3–22 questionnaire 288–294PubMed

25.

Hirano Y et al (2006) Efficacy of multi-slice computed tomography cholangiography before laparoscopic cholecystectomy. ANZ J Surg 76(8):693–695CrossRefPubMed

26.

Deziel DJ et al (1993) Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases. Am J Surg 165(1):9–14CrossRefPubMed

27.

Fletcher DR et al (1999) Complications of cholecystectomy: risks of the laparoscopic approach and protective effects of operative cholangiography: a population-based study. Ann Surg 229(4):449–457CrossRefPubMed

Title: Is routine MR cholangiopancreatography (MRCP) justified prior to cholecystectomy?
Authors: C. A. Nebiker
S. A. Baierlein
S. Beck
M. von Flüe
C. Ackermann
R. Peterli
Publication date: 01-11-2009
Publisher: Springer-Verlag
Published in: Langenbeck's Archives of Surgery / Issue 6/2009
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-008-0447-7

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Is routine MR cholangiopancreatography (MRCP) justified prior to cholecystectomy?

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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