Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Journal of Hepato-Biliary-Pancreatic Sciences
Published in: Journal of Hepato-Biliary-Pancreatic Sciences 4/2012

Open Access 01-07-2012 | Original article

Preoperative MRCP to detect choledocholithiasis in acute calculous cholecystitis

Authors: Hon-Phin Wong, Yu-Lun Chiu, Bei-Hao Shiu, Lu-Chang Ho

Published in: Journal of Hepato-Biliary-Pancreatic Sciences | Issue 4/2012

Login to get access

Abstract

Purpose

There are risks of common bile duct (CBD) stones in acute cholecystitis, and there is a move among surgeons to identify choledocholithiasis before surgery. Magnetic resonance cholangiopancreaticography (MRCP) has the potential to accurately detect choledocholithiasis in patients with acute cholecystitis. The aim of this study was to evaluate the predictive values of MRCP and elevated biochemical predictors for choledocholithiasis in patients with acute cholecystitis.

Methods

Between September 2006 and August 2008, of 84 patients with acute cholecystitis based on the diagnosis criteria of the Tokyo guidelines, 57 had MRCP preoperatively. The predictive values of six biochemical predictors for choledocholithiasis were also evaluated.

Results

Of the 57 patients, seven (12.28%) had choledocholithiasis, of whom three had CBD stones in nondilated ducts. The smallest stone detected in a dilated CBD and nondilated duct was 3.19 and 4.55 mm in diameter, respectively. None of our patients whose MRCP showed a clear CBD returned with symptomatic choledocholithiasis during the follow-up period. All biochemical predictors and CBD diameter had limited positive predictive values.

Conclusions

Magnetic resonance cholangiopancreaticography is a reliable evaluation technique for the detection of choledocholithiasis. It reduces the misdiagnosis of retained choledocholithiasis with normal biochemical predictors and prevents the risk of overlooking choledocholithiasis. No single predictor or combined markers have been found to be reliable for including/excluding the presence of choledocholithiasis.
Literature
1.
Barkun AN, Barkun JS, Fried GM, Ghitulescu G, Steinmetz O, Pham C, et al. Useful predictors of bile duct stones in patients undergoing laparoscopic cholecystectomy. McGill Gallstone Treatment Group. Ann Surg. 1994;220:32–9.PubMedCrossRef
2.
Yang MH, Chen TH, Wang SE, Tsai YF, Su CH, Wu CW, et al. Biochemical predictors for absence of common bile duct stones in patients undergoing laparoscopic cholecystectomy. Surg Endosc. 2008;22:1620–4.PubMedCrossRef
3.
Hauer-Jensen M, Karesen R, Nygaard K, Solheim K, Amlie E, Havig O, et al. Predictive ability of choledocholithiasis indicators. A prospective evaluation. Ann Surg. 1985;202:64–8.PubMedCrossRef
4.
Peng WK, Sheikh Z, Paterson-Brown S, Nixon SJ. Role of liver function tests in predicting common bile duct stones in acute calculous cholecystitis. Br J Surg. 2005;92:1241–7.PubMedCrossRef
5.
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;11:928–32.PubMedCrossRef
6.
Lapis JL, Orlando RC, Mittelstaedt CA, Staab EV. Ultrasonography in the diagnosis of obstructive jaundice. Ann Intern Med. 1978;89:61–3.PubMed
7.
Chang CW, Chang WH, Lin CC, Chu CH, Wang TE, Shih SC. Acute transient hepatocellular injury in cholelithiasis and cholecystitis without evidence of choledocholithiasis. World J Gastroenterol. 2009;15:3788–92.PubMedCrossRef
8.
Pasanen PA, Partanen KP, Pikkarainen PH, Alhava EM, Janatuinen EK, Pirinen AE. A comparison of ultrasound, computed tomography and endoscopic retrograde cholangiopancreatography in the differential diagnosis of benign and malignant jaundice and cholestasis. Eur J Surg. 1993;159:23–9.PubMed
9.
Brisbois D, Plomteux O, Nchimi A, Hock D, Dupont P, Delforge M, et al. Value of MRCP for detection of choledocholithiasis in symptomatic patients: one-year experience with a standardized high resolution breath-hold technique. JBR-BTR. 2001;84:258–61.PubMed
10.
Hirota M, Takada T, Kawarada Y, Nimura Y, Miura F, Hirata K, et al. Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo guidelines. J Hepatobiliary Pancreat Surg. 2007;14:78–82.PubMedCrossRef
11.
Peng WK, Sheikh Z, Nixon SJ, Paterson-Brown S. Role of laparoscopic cholecystectomy in the early management of acute gallbladder disease. Br J Surg. 2005;92:586–91.PubMedCrossRef
12.
Nebiker CA, Baierlein SA, Beck S, von Flue M, Ackermann C, Peterli R. Is routine MR cholangiopancreatography (MRCP) justified prior to cholecystectomy? Langenbecks Arch Surg. 2009;394:1005–10.PubMedCrossRef
13.
Laing FC, Jeffrey RB Jr. Choledocholithiasis and cystic duct obstruction: difficult ultrasonographic diagnosis. Radiology. 1983;146:475–9.PubMed
14.
Cronan JJ, Mueller PR, Simeone JF, O’Connell RS, van Sonnenberg E, Wittenberg J, et al. Prospective diagnosis of choledocholithiasis. Radiology. 1983;146:467–9.PubMed
15.
Parulekar SG, McNamara MP Jr. Ultrasonography of choledocholithiasis. J Ultrasound Med. 1983;2:395–400.PubMed
16.
Laing FC, Jeffrey RB, Wing VW. Improved visualization of choledocholithiasis by sonography. AJR Am J Roentgenol. 1984;143:949–52.PubMed
17.
Neitlich JD, Topazian M, Smith RC, Gupta A, Burrell MI, Rosenfield AT. Detection of choledocholithiasis: comparison of unenhanced helical CT and endoscopic retrograde cholangiopancreatography. Radiology. 1997;203:753–7.PubMed
18.
Baron RL. Diagnosing choledocholithiasis: how far can we push helical CT? Radiology. 1997;203:601–3.PubMed
19.
Brink JA, Kammer B, Mueller PR, Balfe DM, Prien EL, Ferrucci JT. Prediction of gallstone composition: synthesis of CT and radiographic features in vitro. Radiology. 1994;190:69–75.PubMed
20.
Dooms GC, Fisher MR, Higgins CB, Hricak H, Goldberg HI, Margulis AR. MR imaging of the dilated biliary tract. Radiology. 1986;158:337–41.PubMed
21.
Wallner BK, Schumacher KA, Weidenmaier W, Friedrich JM. Dilated biliary tract: evaluation with MR cholangiography with a T2-weighted contrast-enhanced fast sequence. Radiology. 1991;181:805–8.PubMed
22.
Tranter SE, Thompson MH. Spontaneous passage of bile duct stones: frequency of occurrence and relation to clinical presentation. Ann R Coll Surg Engl. 2003;85:174–7.PubMedCrossRef
23.
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;239:28–33.PubMedCrossRef
24.
Fulcher AS, Turner MA, Capps GW, Zfass AM, Baker KM. Half-Fourier RARE MR cholangiopancreatography: experience in 300 subjects. Radiology. 1998;207:21–32.PubMed
25.
Dalton SJ, Balupuri S, Guest J. Routine magnetic resonance cholangiopancreatography and intra-operative cholangiogram in the evaluation of common bile duct stones. Ann R Coll Surg Engl. 2005;87:469–70.PubMedCrossRef
26.
Demartines N, Eisner L, Schnabel K, Fried R, Zuber M, Harder F. Evaluation of magnetic resonance cholangiography in the management of bile duct stones. Arch Surg. 2000;135:148–52.PubMedCrossRef
27.
Topal B, Van de Moortel M, Fieuws S, Vanbeckevoort D, Van Steenbergen W, Aerts R, et al. The value of magnetic resonance cholangiopancreatography in predicting common bile duct stones in patients with gallstone disease. Br J Surg. 2003;90:42–7.PubMedCrossRef
28.
Dwerryhouse SJ, Brown E, Vipond MN. Prospective evaluation of magnetic resonance cholangiography to detect common bile duct stones before laparoscopic cholecystectomy. Br J Surg. 1998;85:1364–6.PubMedCrossRef
29.
Carlos RC, Scheiman JM, Hussain HK, Song JH, Francis IR, Fendrick AM. Making cost-effectiveness analyses clinically relevant: the effect of provider expertise and biliary disease prevalence on the economic comparison of alternative diagnostic strategies. Acad Radiol. 2003;10:620–30.PubMedCrossRef
30.
Richardson MC, Bell G, Fullarton GM. Incidence and nature of bile duct injuries following laparoscopic cholecystectomy: an audit of 5913 cases. West of Scotland Laparoscopic Cholecystectomy Audit Group. Br J Surg. 1996;83:1356–60.PubMedCrossRef
31.
Kaltenthaler E, Vergel YB, Chilcott J, Thomas S, Blakeborough T, Walters SJ, et al. A systematic review and economic evaluation of magnetic resonance cholangiopancreatography compared with diagnostic endoscopic retrograde cholangiopancreatography. Health Technol Assess. 2004; 8:iii1–89.
32.
Sahai AV, Devonshire D, Yeoh KG, Kay C, Feldman D, Willner I, et al. The decision-making value of magnetic resonance cholangiopancreatography in patients seen in a referral center for suspected biliary and pancreatic disease. Am J Gastroenterol. 2001;96:2074–80.PubMedCrossRef
Metadata
Title
Preoperative MRCP to detect choledocholithiasis in acute calculous cholecystitis
Authors
Hon-Phin Wong
Yu-Lun Chiu
Bei-Hao Shiu
Lu-Chang Ho
Publication date
01-07-2012
Publisher
Springer Japan
Published in
Journal of Hepato-Biliary-Pancreatic Sciences / Issue 4/2012
Print ISSN: 1868-6974
Electronic ISSN: 1868-6982
DOI
https://doi.org/10.1007/s00534-011-0456-8

Other articles of this Issue 4/2012

Journal of Hepato-Biliary-Pancreatic Sciences 4/2012 Go to the issue

Retraction Note

Retraction Note: Preoperative endoscopic pancreatic stenting: a novel prophylactic measure against pancreatic fistula after distal pancreatectomy

Original article

The risk factors of fungal infection in living-donor liver transplantations

Topics

Adjuvant chemotherapy with gemcitabine and S-1 after surgical resection for advanced biliary carcinoma: outcomes and prognostic factors

Original Article

Branched-chain amino acid-enriched nutrients improve nutritional and metabolic abnormalities in the early post-transplant period after living donor liver transplantation

Topics

Possibility of immunotherapy for biliary tract cancer: how do we prove efficacy? Introduction to a current ongoing phase I and randomized phase II study to evaluate the efficacy and safety of adding Wilms tumor 1 peptide vaccine to gemcitabine and cisplatin for the treatment of advanced biliary tract cancer (WT-BT trial)

Original article

Negative impact of low body mass index on surgical outcomes after hepatectomy for hepatocellular carcinoma