P-BN39 The perils of MRCP requesting and early associations of data quality and likelihood of a diagnostic result

Abstract Background MRCP (Magnetic resonance cholangiopancreatography) is used most to assess the biliary tree for stones or strictures. Recently, MRCP availability has increased, and it is extensively used to detect of common bile duct (CBD)stones although very frequently no stones are seen. Indeed, the currently recruiting sunflower RCT aims to determine the clinical and cost effectiveness of expectant management versus MRCP in patients undergoing laparoscopic cholecystectomy at low or moderate risk of common bile duct stones. However, it is critical when requesting an investigation that adequate information is provided. This work aimed, to describe the adequacy of information provided and correlate this with the MRCP result. We hypothesised that the less information that was provided the more common a normal result would be. Methods For a three month period (January 2021 to April 2021) all MRCP requests to detect the presence of a CBD stone were reviewed and data obtained from the Radiology CRIS (CDN Radiology Information System, CDN, Sydney, Aus.). The requesting information was compared to three pre-defined criteria (CBD diameter, presence of gallstones and LFT details) that were agreed as the optimal information that a reporting radiologist would require. The number of key pieces of information for each request and whether the request identified a CBD stone were identified. The proportion of MRCPs detecting a CBD stone was calculated according to the number of key pieces of information provided. Results 56 patients were identified, of which 16 (29%) patients had CBD stones. In 24/56 (43%) patients the presence of gallstones on a previous ultrasound was provided, 14/56 (25%) of patients had information about LFTs including bilirubin and a trend in LFTs was not stated for any patient (0/56; 0%). The rate of stone detection was calculated by the number of pieces of information provided. The rate was 71% (5/7) when all 3 pieces of data were provided, 31% (2/13) when two piece of information were provided, 30% (8/27) when a single piece of information was provided, and only 11% (1/11) when none of the specified data were provided. Conclusions It is uncommon for adequate clinical information to be provided in MRCP requests and in 16% of request no key information was provided. The LFT results were frequently omitted and the trend in LFTs never stated. The more key data provided in the request saw a higher proportion of MRCPs where a CBD stone was identified. We recommend that maximal clinical information is mandated for MRCP request perhaps using mandatory fields on electronic requesting systems and that these systems are also used to facilitate recruitment to clinical trials such the Sunflower RCT.

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Accuracy of Ultrasound and Magnetic Resonance Cholangiopancreatography Findings in the Diagnosis of Biliary System Stones

Pertanika Journal of Science and Technology ◽

10.47836/pjst.30.1.46 ◽

2022 ◽

Vol 30 (1) ◽

pp. 841-852

Author(s):

Abdullah Taher Naji ◽

Ameen Mohsen Amer ◽

Saddam Mohammed Alzofi ◽

Esmail Abdu Ali ◽

Noman Qaid Alnaggar

Keyword(s):

Bile Duct ◽

Magnetic Resonance ◽

Common Bile Duct ◽

Common Bile Duct Stones ◽

Magnetic Resonance Cholangiopancreatography ◽

Final Diagnosis ◽

Biliary System ◽

Cbd Stones ◽

System Diagnosis ◽

Us Findings

This study aimed to evaluate the diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) and Ultrasound (US) images for the diagnosis of biliary system stones, as well as to assess the consistency between MRCP and US findings. The study sample included 200 cases (90 males and 110 females) with symptomatic biliary system stones between 14 and 82 years. All cases underwent both the US and MRCP imaging for biliary system diagnosis. The study revealed that the most prominent age group with symptoms of biliary system stones was the 33-60-year-old group. It also found that the accuracy of US and MRCP in detecting gallbladder (GB) stones compared with the final diagnosis was 94% and 91%, respectively, with moderate conformity between their results. The accuracy of US and MRCP images in detecting common bile duct (CBD) stones was 61% and 98%, respectively, with fair conformity between their results. In addition, there is a significant agreement between the MRCP and US results in detecting the GB and CBD stones with an agreed percentage of 74% and 71%, respectively. The study concluded that US is the preferred imaging technique for patients with symptomatic gallbladder stones, whereas MRCP is a trustworthy investigation for common bile duct stones.

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The Role of Magnetic Resonance Cholangiopancreatography in the Diagnosis of Choledocholithiasis: Do Benefits Outweigh the Costs?

The American Surgeon ◽

10.1177/000313481508100723 ◽

2015 ◽

Vol 81 (7) ◽

pp. 720-725 ◽

Cited By ~ 9

Author(s):

William H. Ward ◽

Laura M. Fluke ◽

Benjamin D. Hoagland ◽

Gregory J. Zarow ◽

Jenny M. Held ◽

...

Keyword(s):

Bile Duct ◽

Magnetic Resonance ◽

Length Of Stay ◽

Common Bile Duct ◽

Predictive Value ◽

Demographic Data ◽

Common Bile Duct Stones ◽

Magnetic Resonance Cholangiopancreatography ◽

Biliary Tree ◽

Bile Duct Stones

Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard in evaluation of the biliary tree for choledocholithiasis. Formal indications for magnetic resonance cholangiopancreatography (MRCP) in suspected choledocholithiasis are lacking. Our objective was to determine if MRCP affects management of patients who otherwise would undergo ERCP. A review was conducted of all MRCPs and ERCPs at our institution from 2008 to 2012 with suspected choledocholithiasis. Patients who underwent MRCP and ERCP were compared with those who underwent ERCP alone. Demographic data were collected and notation of whether a post-MRCP ERCP occurred was the primary variable. MRCP was performed in 107 patients for choledocholithiasis. Eighty-eight patients were negative for choledocholithiasis (82%) and 76 were discharged without ERCP (71%). Thirty-one patients received a diagnosis of choledocholithiasis and were referred for ERCP. Of the 19 patients with MRCP-diagnosed common bile duct stones, 95 per cent were confirmed by ERCP (odds ratio 18.0, P > 0.05; agreement 77%, sensitivity 0.76, specificity 0.86, positive predictive value 0.95, negative predictive value 0.50). Length of stay was similar for all groups. A total of 131 patients underwent ERCP without a preprocedural MRCP. Choledocholithiasis was found in 116 patients (92%), whereas 12 patients (9%) had no common bile duct stones and three had an alternate diagnosis. In conclusion, MRCP significantly affected the management of patients who would have undergone ERCP. MRCP did not increase length of stay and contributed to the 95 per cent positivity rate of subsequent ERCPs. These data illustrate the utility of MRCP in suspected choledocholithiasis patients at a low cost with regard to risk and time.

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LAPAROSCOPIC MANAGEMENT OF COMMON BILE DUCT STONES

10.36106/ijsr/7223545 ◽

2020 ◽

pp. 1-4

Author(s):

Binit Prasad ◽

Mukesh Kumar ◽

Debarshi Jana

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Open Surgery ◽

Common Bile Duct Stones ◽

Single Stage ◽

Bile Duct Stones ◽

Cbd Stones ◽

Cbd Stone ◽

Laparoscopic Cbd Exploration ◽

Cbd Exploration

Introduction: Common Bile Duct stones (CBD) are found in approximately 16% of the patients undergoing Laparoscopic cholecystectomy (LC). Till recently, the gold standard for treating CBD stones was endoscopic removal, if that failed, then open surgery. However, in the laparoscopic era, the best treatment for CBD stones is a matter of debate and it continues to evolve. The objective of the present study is to determine that laparoscopic CBD exploration (LCBDE) is a safe, feasible and single-stage option for the management of CBD stones. Materials and Methods :Out of the 2900 laparoscopic cholecystectomies we did selective intraoperative cholangiogram in 262 patients who were suspected to have CBD stones based on deranged liver function tests, dilated CBD with or without CBD stone on sonography or having the history of recent jaundice/pancreatitis. If CBD stone was found, either a transcystic or transcholedochal exploration was done depending on the size, site, number of stones and CBD diameter. Choledochotomy was closed over a t-tube in the majority of the patients. Primary closure of CBD was done in few patients and in one patient we placed an antegrade stent and in another we placed endoscopic stent into the CBD laparoscpically which was removed after four weeks. Results :Till date we have performed LCBDE in 64 patients. Transcystic exploration was done in 14 patients and transcholedochal exploration was done in 46 cases out of which 2 patients had minor biliary leak which settled on conservative treatment in 2-3 days. Four patients required conversion to open surgery as there were multiple stones. We did not have any major complication and on 6 months follow-up in 76% patients, none was found to have residual stone. Conclusion :The treatment of CBD stones depends on the resources available, technical limitations and the surgeon’s expertise. Laparoscopic CBD exploration is a safe, feasible and single-stage option for the management of CBD stones.

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Common bile duct stones: its different aspects of presentation and management

International Surgery Journal ◽

10.18203/2349-2902.isj20202837 ◽

2020 ◽

Vol 7 (7) ◽

pp. 2289

Author(s):

Nishant Kumar

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Common Bile Duct Stones ◽

Medical Sciences ◽

Radiological Findings ◽

Cbd Stones ◽

The Mean ◽

Cbd Stone ◽

Surgery Department ◽

Potential Challenge

Background: Common bile duct (CBD) stone management is a commonly occurring potential challenge for surgeons.Methods: A total of 38 patients who was admitted in admitted in surgery Department of Sri Ram Institute of Medical Sciences, Bareilly UP during the period of March 2019 to September 2019 were studied. The diagnosis was made using USG MRCP, relevant blood investigations. Patients were managed based on radiological findings by the best possible way and expertise available.Results: Out of the 38 patients, 14 (37.14%) were male and 24 (62.85%) were female. The mean age for male was 50.92 years and for female, it was 51.74 yrs. Most of the patients had pain abdomen and /or jaundice with a mean total bilirubin of 3 mg/dl. Patients are managed either by ERCP or by surgery (open/laparoscopic). Mortality is nil but morbidity is more for open procedures.Conclusions: There can be no definite algorithm for the management of CBD stones as the patients’ age, underlying general condition being the only standardizable factor with facilities for endoscopic, laparoscopic management being variably available from institution to institution and hence, necessitating tailoring the management of CBD stones depending upon the Institution’s resources.

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ERCP Following Laparoscopic Cholecystectomy: A Safe and Effective way to Manage CBD Stones and Complications

HPB Surgery ◽

10.1155/1995/58905 ◽

1995 ◽

Vol 8 (3) ◽

pp. 187-192 ◽

Cited By ~ 11

Author(s):

Colleen M. Schmitt ◽

John Baillie ◽

Peter B. Cotton

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Common Bile Duct ◽

Common Bile Duct Stones ◽

Biliary Tree ◽

Bile Duct Stones ◽

Operative Complication ◽

Cbd Stones ◽

Bile Duct Injuries

The efficacy of ERCP in detecting and treating post-laparoscopic cholecystectomy problems was examined in a series of consecutive patients undergoing directed examination of the biliary tree over a two-year period. Three major diagnostic groups were identified: leaks and bile duct injuries (n = 9), retained common bile duct stones (n = 18), and post-cholecystectomy pain (n = 13). These diagnostic groups differed in degree of abnormal bilirubin (p = .004) and time between surgery and ERCP (p = .0005). Diagnosis of a post-operative complication was successful in 92% of attempted cases. Therapy was successful in 92% of attempted cases. Three patients developed mild pancreatitis as a result of ERCP. This series underscores the efficacy of a multi-disciplinary approach to problems which occur after laparoscopic cholecystectomy.

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Surgical procedure for unexpected balloon burst complication during endoscopic balloon dilatation in a patient with common bile duct stones

Surgical Case Reports ◽

10.1186/s40792-020-01014-5 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Koji Morishita ◽

Hideaki Sasaki

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Balloon Dilatation ◽

Rare Complication ◽

Common Bile Duct Stones ◽

Endoscopic Retrograde ◽

Case Presentation ◽

Endoscopic Balloon Dilatation ◽

Cbd Stones ◽

Endoscopic Balloon

Abstract Background Endoscopic balloon dilatation (EBD) is the established treatment for common bile duct (CBD) stones. Although pancreatitis and bleeding have been reported as major complications of EBD, balloon-related complications are rarely reported in EBD. Case presentation A 30-year-old woman with suspected CBD stones underwent endoscopic retrograde cholangiopancreatography (ERCP) and EBD. During EBD, the balloon of the EBD catheter suddenly burst at the biliary sphincter. We therefore performed surgical intervention: removal of the broken EBD catheter and T-tube drainage. Finally, the patient was discharged without any complications. Conclusions We present a case involving a burst balloon of an EBD catheter as a rare complication during EBD, as well as the surgical technique that was used to treat this complication.

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Laparoscopic CBD Exploration (LCBDE) a better and safe option for large CBD stones

10.53350/pjmhs211561321 ◽

2021 ◽

Vol 15 (6) ◽

pp. 1321-1323

Author(s):

I. Sadiq ◽

A. Malik ◽

J. K. Lodhi ◽

S. T. Bukhari ◽

R. Maqbool ◽

...

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Bile Leak ◽

Common Bile Duct Stones ◽

Common Bile Duct Exploration ◽

Open Approach ◽

Cbd Stones ◽

Duration Of Surgery ◽

Laparoscopic Cbd Exploration ◽

Cbd Exploration

Background: Conventionally, common bile duct stones (CBDS) are removed with help of ERCP. However, if CBDS are larger than 10 mm, then the ERCP failure rate to retrieve CBDS becomes high. In that case, open or laparoscopic common bile duct exploration (LCBDE) is other alternative. In this era of minimally invasive surgery, laparoscopic CBD exploration (LCBDE) seems to be a better option than open approach, but in our set up the safety of LCBDE is questioned. Aim: To see the conversion rate as well as complications associated with LCBDE. Material & Methods: Methods: This is a retrospective analysis of data of patients who underwent Laparoscopic Common Bile Duct Exploration (LCBDE) for large CBD stones at Fatima Memorial Hospital Lahore. Results: Since 2012, 29 patients of large (≥10 mm) CBD stones were included in this study. Among them 20(69.9%) were females and 9(31.01%) were males. The mean CBD stone size was 13 mm. Stones were extracted transcystically in 4 case and Transcholedochal stone extraction was done in 25 cases. The average duration of surgery was 130 minutes, but all cases were completed successfully without converting to open approach. There was minor bile leak in 3 patients which was managed successfully without any further intervention. No other complication was observed with LCBDE and even no retained stone was reported. Conclusion: Laparoscopic CBD exploration is safe and effective method of dealing CBD stones especially of large size when the chances of ERCP failure to retrieve stones are high. Keywords: Laparoscopy, ERCP, common bile duct,

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