Intraoperative cholangiography: A century‐old practice and still debated

Abstract Background: The optimal approach for patients with gallbladder stones and intermediate risk for choledocholithiasis still remains undetermined. Use of diagnostic endoscopic retrograde cholangiopancreatography should be minimized as it carries considerable risk of post-procedural complications. This study compares two different management strategies: intraoperative cholangiography and endoscopic ultrasound before laparoscopic cholecystectomy for patients with symptomatic cholecystolithiasis and intermediate risk for choledocholithiasis. Methods: It is a diagnostic randomized active-controlled single-centre clinical trial enrolling adult patients undergoing laparoscopic cholecystectomy due to symptomatic gallbladder stones with intermediate risk for choledocholithiasis. The risk for choledocholithiasis is calculated using an original prognostic score – Vilnius University Hospital Index. A total of 106 participants will be included and randomized into two groups. Evaluation of bile ducts using endoscopic ultrasound and endoscopic retrograde cholangiography on demand will be performed before laparoscopic cholecystectomy for one arm (“Endoscopy first”). Intraoperative cholangiography during laparoscopic cholecystectomy and postoperative endoscopic retrograde cholangiopancreatography on demand will be administered in another arm (“Cholecystectomy first”). Postoperative follow-up is 6 months. The primary endpoint is the length of hospital stay. Secondary endpoints will include accuracy of the different management strategies, adverse events of interventions, duct clearance and technical success of interventions (intraoperative cholangiography, endoscopic ultrasound, endoscopic retrograde cholangiography), costs of treatment. Discussion: This trial is planned determine which strategy is better approach for a patient with intermediate common bile duct stones risk and to define a simple to calculate and safe algorithm on managing choledocholithiasis. Trial registration: The trial is registered at ClinicalTrials.gov, identification number NCT03658863.

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Role of Intraoperative Cholangiography in Patients Whose Biliary Tree Was Evaluated Preoperatively by Magnetic Resonance Cholangiopancreatography

World Journal of Surgery ◽

10.1007/s00268-012-1715-9 ◽

2012 ◽

Vol 36 (11) ◽

pp. 2661-2665 ◽

Cited By ~ 9

Author(s):

Kimihiko Ueno ◽

Tetsuo Ajiki ◽

Hidehiro Sawa ◽

Ippei Matsumoto ◽

Takumi Fukumoto ◽

...

Keyword(s):

Magnetic Resonance ◽

Magnetic Resonance Cholangiopancreatography ◽

Biliary Tree ◽

Intraoperative Cholangiography

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Associations between Vitamin D and Liver Function and Liver Fibrosis in Patients with Biliary Atresia

Gastroenterology Research and Practice ◽

10.1155/2019/4621372 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

Peijun Zhuang ◽

Song Sun ◽

Rui Dong ◽

Gong Chen ◽

Yanlei Huang ◽

...

Keyword(s):

Vitamin D ◽

Alkaline Phosphatase ◽

Liver Fibrosis ◽

Liver Function ◽

Confidence Interval ◽

Biliary Atresia ◽

Odds Ratio ◽

Intraoperative Cholangiography ◽

Preoperative Serum ◽

Histopathologic Features

Objectives. To detail the effects of vitamin D (VD) deficiency and assess the relationships between VD deficiency and liver function and liver fibrosis in patients with biliary atresia (BA). Methods. In this study, BA patients confirmed by intraoperative cholangiography were enrolled between January 2017 and February 2019. Preoperative serum 25-(OH)D level, liver function, serum biomarker levels of liver fibrosis, and histopathologic features were recorded. Deficiency, insufficiency, and sufficiency of VD were defined as serum 25-(OH)D concentrations of <10, 10-20, and >20 ng/ml, respectively. Associations between serum 25-(OH)D level and liver function and liver fibrosis were analyzed. Results. A total of 161 BA infants were included. The median (interquartile range (IQR)) serum 25-(OH)D level in all patients was 7.56 (IQR: 4.48–11.40) ng/ml. The rates of 25-(OH)D deficiency, insufficiency, and sufficiency were 67.1% (108/161), 29.2% (47/161), and 3.7% (6/161), respectively. Serum 25-(OH)D level was negatively correlated with alkaline phosphatase (r=‐0.232, P=0.003). After adjusting for age, a decrease in serum 25-(OH)D level was correlated with the increase of the Batts-Ludwig stage score (odds ratio (OR): 0.94, 95% confidence interval (CI): 0.88–0.99; P=0.028). Serum 25-(OH)D level was also correlated with the N-terminal propeptide of type III procollagen (PIIINP) (r=‐0.246, P=0.002). Additionally, PIIINP (P=0.038) and ALP (P=0.031) were independently associated with serum 25-(OH)D level. Conclusions. VD deficiency was common and inversely correlated with liver fibrosis in BA patients. Furthermore, VD was not correlated with liver function except alkaline phosphatase.

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