1
|
Rauh JL, Dantes G, Alemayehu H, Wallace M, Zamora IJ, Callier K, Slater BJ, Krinock D, Siddiqui S, Witte A, Flynn-O-Brien K, Patwardhan UM, Ignacio R, Gomez MK, Neff LP. Reducing MRCP Utilization Through a "Surgery First" Approach for Pediatric Choledocholithiasis: A CARES Working Group Retrospective Study. J Pediatr Surg 2024:161668. [PMID: 39232947 DOI: 10.1016/j.jpedsurg.2024.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/31/2024] [Accepted: 08/02/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND Choledocholithiasis in children is rising and frequently managed with an endoscopy-first (EF) approach that utilizes endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC). Magnetic resonance cholangiopancreatography (MRCP) is a resource intensive modality that often precedes ERCP to gain further assurance of choledocholithiasis prior to intervention. MRCP can lead to a longer length of stay (LOS) and strain healthcare resources. We hypothesized that the use of MRCP is decreased with a surgery-first (SF) approach. METHODS The Choledocholithiasis Alliance for Research, Education, and Surgery (CARES) Working Group conducted this retrospective study on pediatric patients with suspected choledocholithiasis. SF patients underwent LC + intraoperative cholangiogram (IOC) ± laparoscopic common bile duct exploration (LCBDE). Imaging studies included ultrasound (US), MRCP, and computed tomography (CT). RESULTS From seven institutions, 357 pediatric patients were identified. The SF (n = 220) group received fewer imaging studies then EF (n = 137) (1.29 vs. 1.62; p < 0.05). US was more commonly employed and the number of US and CT scans was similar. The SF group had lower MRCP utilization than EF (29% vs. 59%; p < 0.05). EF patients that received an MRCP had the longest LOS (4.0 d [2.4, 6.3]) compared to SF that did not (1.9 d [1.2, 3.2]) (p < 0.05). CONCLUSION Children with choledocholithiasis managed with an EF approach receive more diagnostic imaging, especially MRCP. While MRCP remains a powerful diagnostic tool, a surgery-first approach can minimize the resource utilization and LOS associated with magnetic resonance imaging. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Derek Krinock
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sabina Siddiqui
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | | | | | | | | | - Lucas P Neff
- Wake Forest School of Medicine, Winston Salem, USA
| |
Collapse
|
2
|
Staubli SM, Kettelhack C, Oertli D, von Holzen U, Zingg U, Mattiello D, Rosenberg R, Mechera R, Rosenblum I, Pfefferkorn U, Kollmar O, Nebiker CA. Efficacy of intraoperative cholangiography versus preoperative magnetic resonance cholangiography in patients with intermediate risk for common bile duct stones. HPB (Oxford) 2022; 24:1898-1906. [PMID: 35817694 DOI: 10.1016/j.hpb.2022.05.1346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/24/2022] [Accepted: 05/31/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND This is the first randomized trial to evaluate the efficacy of intraoperative cholangiography (IOC) and magnetic resonance cholangiopancreatography (MRCP) in patients with suspected CBDS. METHODS This unblinded, multicenter RCT was conducted at five swiss hospitals. Eligibility criteria were suspected CBDS. Patients were randomized to IOC and laparoscopic cholecystectomy (LC), followed by endoscopic retrograde cholangiopancreatography (ERCP) if needed, or MRCP followed by ERCP if needed, and LC. Primary outcome was length of stay (LOS), secondary outcomes were cost, stone detection, and complication rates. RESULTS 122 Patients were randomised to the IOC Group (63) or the MRCP group (59). Median LOS for the IOC and the MRCP groups were 4 days IQR [3, 6] and [4, 6], with an estimated increase of LOS of 1.2 days in the MRCP group (p = 0.0799) in the linear model. Median cost in the IOC and MRCP groups were 10 473 Swiss Francs (CHF) and 10 801 CHF, respectively (p = 0.694). CBDS were found in 24 and 12 patients in the IOC and the MRCP groups, respectively (p = 0.0387). The complication rate did not differ between both groups. CONCLUSION There is equipoise between both pathways. IOC has a significantly higher diagnostic yield than MRCP. TRIAL REGISTRATION Clinicaltrials.gov identifier NCT02351492: Radiological Investigation of Bile Duct Obstruction (RIBO).
Collapse
Affiliation(s)
- Sebastian M Staubli
- Clarunis, University Center for Gastrointestinal and Liver Disease Basel, Basel, Switzerland; Department of Surgery, Cantonal Hospital Baselland, Liestal, Switzerland; Clinical Service of HPB Surgery and Liver Transplantation, Royal Free London Hospital, NHS Foundation Trust, London, NW3 2QG, UK
| | - Christoph Kettelhack
- Clarunis, University Center for Gastrointestinal and Liver Disease Basel, Basel, Switzerland
| | - Daniel Oertli
- Department of Surgery, University Hospital Basel, Basel, Switzerland
| | - Urs von Holzen
- Department of Surgery, University Hospital Basel, Basel, Switzerland; Harper Cancer Research Institute, Indiana University School of Medicine South Bend, South Bend, IN, United States; Goshen Center for Cancer Care, Goshen, IN, United States
| | - Urs Zingg
- Department of Surgery, Limmattal Hospital, Zurich-Schlieren, Switzerland
| | - Diana Mattiello
- Department of Surgery, Limmattal Hospital, Zurich-Schlieren, Switzerland
| | - Robert Rosenberg
- Department of Surgery, Cantonal Hospital Baselland, Liestal, Switzerland; Clinical Service of HPB Surgery and Liver Transplantation, Royal Free London Hospital, NHS Foundation Trust, London, NW3 2QG, UK
| | - Robert Mechera
- Clarunis, University Center for Gastrointestinal and Liver Disease Basel, Basel, Switzerland; Department of Surgery, Cantonal Hospital Baselland, Liestal, Switzerland; Clinical Service of HPB Surgery and Liver Transplantation, Royal Free London Hospital, NHS Foundation Trust, London, NW3 2QG, UK
| | - Ilan Rosenblum
- Clinical Service of HPB Surgery and Liver Transplantation, Royal Free London Hospital, NHS Foundation Trust, London, NW3 2QG, UK
| | - Urs Pfefferkorn
- Department of Surgery, Hospital Dornach, Dornach, Switzerland
| | - Otto Kollmar
- Clarunis, University Center for Gastrointestinal and Liver Disease Basel, Basel, Switzerland
| | | |
Collapse
|
3
|
Mattila A, Pynnönen E, Sironen A, Elomaa E, Mrena J, Jalkanen A, Nevalainen M, Helminen O. Routine preoperative MRCP in screening choledocholithiasis in acute cholecystitis compared to selective approach: a population-based study. Updates Surg 2022; 75:563-570. [PMID: 36207660 DOI: 10.1007/s13304-022-01390-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/22/2022] [Indexed: 11/24/2022]
Abstract
Choledocholithiasis is more common in acute cholecystitis than in elective situations. Preoperative diagnosis of choledocholithiasis is essential to facilitate adequate planning of CBD (common bile duct) stone removal, preferably performed as a single-stage procedure. The purpose of this study was to test the feasibility of routine preoperative magnetic resonance cholangiopancreatography (MRCP) in acute cholecystitis followed by consequent cholecystectomy. A total of 180 consecutive patients operated for acute cholecystitis between January 2019 and December 2019 were prospectively enrolled. Preoperative routine MRCP was performed for bile duct evaluation when feasible. The control cohort consisted of 180 consecutive patients undergoing emergency laparoscopic cholecystectomy before the study period. Intraoperative cholangiography was used routinely in both groups when technically achievable. We examined the proportion of patients recruited in preoperative MRCP, possible time delay to MRCP and surgery, and the incidence of CBD stones compared to the control cohort. Routine MRCP in acute cholecystitis was achieved in 114/180 (63%) patients compared to 42/180 (23.3%) patients of the control group. The triage time from emergency to MRCP and the operating theatre was similar in both cohorts. The percentage of patients diagnosed with choledocholithiasis in the study group was notably higher (almost 18% vs 11%), p < 0.05. After a median follow-up time of 2.5 years in the study group and almost 4 years in the control group, recurrent choledocholithiasis was not detected in either group. Routine MRCP in patients with acute cholecystitis can be implemented with a fair execution rate in a population-based setting with minor effects on hospital stay and delays but higher detection of choledocholithiasis. We observed no additional benefit compared to the selective use of MRCP. However, routine preoperative MRCP allows an advantage when considering the appropriate exploration method if choledocholithiasis is detected.
Collapse
Affiliation(s)
- Anne Mattila
- Dept. of Surgery, Hospital Nova of Central Finland, Hoitajantie 3, 40620, Jyväskylä, Finland.
| | - Emilia Pynnönen
- Dept. of Radiology, Hospital Nova of Central Finland, Jyväskylä, Finland
| | - Antti Sironen
- Dept. of Radiology, Hospital Nova of Central Finland, Jyväskylä, Finland
| | - Eeva Elomaa
- Dept. of Radiology, Hospital Nova of Central Finland, Jyväskylä, Finland
| | - Johanna Mrena
- Dept. of Surgery, Hospital Nova of Central Finland, Hoitajantie 3, 40620, Jyväskylä, Finland
| | - Aapo Jalkanen
- Dept. of Surgery, Hospital Nova of Central Finland, Hoitajantie 3, 40620, Jyväskylä, Finland
| | - Mika Nevalainen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Olli Helminen
- Dept. of Surgery, Hospital Nova of Central Finland, Hoitajantie 3, 40620, Jyväskylä, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| |
Collapse
|
4
|
Solanki S, Kichloo A, Dahiya DS, Solanki D, Singh J, Wani F, Albosta M, Ghimire S, Haq KF, Khan HM, Jafri SM, Siddiqui MA, Zuchelli T. Endoscopic Retrograde Cholangiopancreatography (ERCP) in Patients With Liver Cirrhosis: Analysis of Trends and Outcomes From the National Inpatient Sample Database. J Clin Gastroenterol 2022; 56:618-626. [PMID: 34107514 PMCID: PMC9257052 DOI: 10.1097/mcg.0000000000001573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 05/06/2021] [Indexed: 01/28/2023]
Abstract
GOALS We aimed to assess outcomes of patients with liver cirrhosis who underwent therapeutic or diagnostic endoscopic retrograde cholangiopancreatography (ERCP) to determine whether these patients had different outcomes relative to patients without cirrhosis. BACKGROUND ERCP is an important procedure for treatment of biliary and pancreatic disease. However, ERCP is relatively technically difficult to perform when compared with procedures such as esophagogastroduodenoscopy or colonoscopy. Little is known about how ERCP use affects patients with liver cirrhosis. STUDY Using patient records from the National Inpatient Sample (NIS) database, we identified adult patients who underwent ERCP between 2009 and 2014 using International Classification of Disease, Ninth Revision coding and stratified data into 2 groups: patients with liver cirrhosis and those without liver cirrhosis. We compared baseline characteristics and multiple outcomes between groups and compared outcomes of diagnostic versus therapeutic ERCP in patients with cirrhosis. A multivariate regression model was used to estimate the association of cirrhosis with ERCP outcomes. RESULTS A total of 1,038,258 hospitalizations of patients who underwent ERCP between 2009 and 2014 were identified, of which 31,294 had cirrhosis and 994,681 did not have cirrhosis. Of the patients with cirrhosis, 21,835 (69.8%) received therapeutic ERCP and 9459 (30.2%) received diagnostic ERCP. Patients with cirrhosis had more ERCP-associated hemorrhages (2.5% vs. 1.2%; P <0.0001) compared with noncirrhosis patients but had lower incidence of perforations (0.1% vs. 0.2%; P <0.0001) and post-ERCP pancreatitis (8.6% vs. 7%; P <0.0001). Cholecystitis was the same between groups (2.3% vs. 2.3%; P <0.0001). In patients with cirrhosis, those who received therapeutic ERCP had higher post-ERCP pancreatitis (7.9% vs. 5.1%; P <0.0001) and ERCP-associated hemorrhage (2.7% vs. 2.1%; P <0.0001) but lower incidences of perforation and cholecystitis (0.1% vs. 0.3%; P <0.0001) and cholecystitis (1.9 vs. 3.1%; P <0.0001) compared with those who received diagnostic ERCP. CONCLUSIONS Use of therapeutic ERCP in patients with liver cirrhosis may lead to higher risk of complications such as pancreatitis and postprocedure hemorrhage, whereas diagnostic ERCP may increase the risk of pancreatitis and cholecystitis in patients with cirrhosis. Comorbidities in cirrhosis patients may increase the risk of post-ERCP complications and mortality; therefore, use of ERCP in cirrhosis patients should be carefully considered, and further studies on this patient population are needed.
Collapse
Affiliation(s)
- Shantanu Solanki
- Department of Medicine, Geisinger Commonwealth School of Medicine, Scranton
| | - Asim Kichloo
- Departments of Medicine
- Department of Medicine, Central Michigan University College of Medicine, Saginaw
| | - Dushyant S. Dahiya
- Department of Medicine, Central Michigan University College of Medicine, Saginaw
| | | | - Jagmeet Singh
- Department of Medicine, Geisinger Commonwealth School of Medicine, Scranton
| | - Farah Wani
- Family Medicine, Samaritan Medical Center, Watertown, NY
| | - Michael Albosta
- Department of Medicine, Central Michigan University College of Medicine, Saginaw
| | | | - Khwaja F. Haq
- Department of Gastroenterology, Henry Ford Hospital, Detroit, MI
| | - Hafiz M.A. Khan
- Department of Gastroenterology, Guthrie Robert Packer Hospital, Sayre, PA
| | | | | | - Tobias Zuchelli
- Department of Gastroenterology, Henry Ford Hospital, Detroit, MI
| |
Collapse
|
5
|
Evaluation of the Compatibility of Preoperative MRCP and Intraoperative Cholangiography in Imaging of the Bile Ducts in Living Donor Liver Transplantation. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03342-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
6
|
Yu B, Zhi X, Li Q, Xu B, Dong Z, Li T, Chen Z. The efficacy and safety of preoperative cholangiography via percutaneous transhepatic gallbladder drainage (PTGBD) for difficult laparoscopic cholecystectomy (LC). Surg Endosc 2021; 36:1355-1361. [PMID: 34013391 DOI: 10.1007/s00464-021-08414-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 02/23/2021] [Indexed: 12/07/2022]
Abstract
BACKGROUND Percutaneous transhepatic gallbladder drainage (PTGBD) is an important procedure for initial treatment of severe acute cholecystitis (AC) that is contraindicated for early laparoscopic cholecystectomy (LC). We presented our primary experience on a new approach of cholangiography via PTGBD (PTGBD-C) for preoperative delineation of biliary anatomy. METHODS A retrospective analysis was conducted on 93 patients who received PTGBD followed by LC for AC, with allocation into 2 groups that were PTGBD with (PTGBD-C group, 32 patients) or without (PTGBD-N group, 61 patients) cholangiography. All the clinical data, including demographics, cholangiography findings, operations, and complications, were collected and analyzed. RESULTS Cholangiography was attempted in 32 patients with a success of 31 cases, and the most common complication was transient fever in 3 patients. PTGBD-C group of patients showed significantly less operation time (83.2 ± 22.32 vs. 106.5 ± 40.25 min, P = 0.041) and conversion rate (0 vs. 2). There was no statistical difference in terms of postoperative hospitalization and complications. CONCLUSIONS PTGBD-C is a feasible and safe procedure for severe AC patients with delayed LC. It has advantages of direct cholangiography, being easy to perform and cost-effective, thus should be considered for clinical usage.
Collapse
Affiliation(s)
- Bingran Yu
- Department of Hepatobiliary Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 West Wen Hua Road, Jinan, 250012, China
| | - Xuting Zhi
- Department of Hepatobiliary Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 West Wen Hua Road, Jinan, 250012, China
| | - Qiong Li
- Department of Hepatobiliary Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 West Wen Hua Road, Jinan, 250012, China
| | - Bowen Xu
- Department of Hepatobiliary Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 West Wen Hua Road, Jinan, 250012, China
| | - Zhaoru Dong
- Department of Hepatobiliary Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 West Wen Hua Road, Jinan, 250012, China
| | - Tao Li
- Department of Hepatobiliary Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 West Wen Hua Road, Jinan, 250012, China.
| | - Zhiqiang Chen
- Department of Hepatobiliary Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 West Wen Hua Road, Jinan, 250012, China.
| |
Collapse
|
7
|
Khatkov IE, Avanesyan RG, Akhaladze GG, Beburishvili AG, Bulanov AY, Bykov MI, Vinnitskaia EV, Virshke ER, Gabriel SA, Granov DA, Darvin VV, Dolgushin BI, Dyuzheva TG, Efanov MG, Korobka VL, Korolev MP, Kulabukhov VV, Maystrenko NA, Melekhina OV, Nedoluzhko IY, Okhotnikov OI, Pogrebnyakov VY, Polikarpov AA, Prudkov MI, Ratnikov VA, Solodinina EN, Stepanova YA, Subbotin VV, Fedorov ED, Shabunin AV, Shapovalyants SG, Shulutko AM, Shishin KV, Tsvirkun VV, Chzhao AV, Kulezneva YV. Diagnostic and conservative treatment nuances in patients with obstructive jaundice: in the wake of Russian consensus. TERAPEVT ARKH 2021; 93:138-144. [DOI: 10.26442/00403660.2021.02.200619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 04/05/2021] [Indexed: 12/07/2022]
Abstract
The research was performed at the Loginov Moscow Clinical Scientific Center. It is based on Russian obstructive jaundice (OJ) consensus results, considered at the 45th annual Central Research Institute of Gastroenterology Scientific session Oncological issues in the gastroenterologist practice (1 March 2019). The article objective is to note the diagnostic and conservative treatment current issues in patients with OJ. The increase in the number of patients with OJ of different etiology provides problem actuality. In a large number of cases, medical treatment is delayed due to inadequate diagnostic and management, while correct patients routing today can be provided regardless of medical institution level. In this article the examination steps and conservative treatment role in patients with biliary obstruction management are presented.
Collapse
|
8
|
Khatkov IE, Avanesyan RG, Akhaladze GG, BeburIshvili AG, Bulanov AY, Bykov MI, Virshke EG, Gabriel SA, Granov DA, Darvin VV, Dolgushin BI, Dyuzheva TG, Efanov MG, Korobka VL, Korolev MP, Kulabukhov VV, Maystrenko NA, Melekhina OV, Nedoluzhko IY, Okhotnikov OI, Pogrebnyakov VY, Polikarpov AA, Prudkov MI, Ratnikov VA, Solodinina EN, Stepanova YA, Subbotin VV, Fedorov ED, Shabunin AV, Shapovalyants SG, Shulutko AM, Shishin KV, Tsvirkun VN, Chzhao AV, Kulezneva YV. [Russian consensus on current issues in the diagnosis and treatment of obstructive jaundice syndrome]. Khirurgiia (Mosk) 2020:5-17. [PMID: 32573526 DOI: 10.17116/hirurgia20200615] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The Russian consensus document on topical issues of the diagnosis and treatment of obstructive jaundice syndrome was prepared by a group of experts in various fields of surgery, endoscopy, interventional radiology, radiological diagnosis and intensive care. The goal of this document is to clarify and consolidate the opinions of national experts on the following issues: timing of diagnosis of obstructive jaundice, features of diagnostic measures, the need and possibility of conservative measures for obstructive jaundice, and strategy of biliary decompression depending on the cause and level of biliary block.
Collapse
Affiliation(s)
- I E Khatkov
- Loginov Moscow Clinical Research Center, Moscow, Russia
| | - R G Avanesyan
- St. Petersburg City Mariinskaya Hospital, St. Petersburg, Russia
| | | | | | - A Yu Bulanov
- Moscow City Clinical Hospital No. 52, Moscow, Russia
| | - M I Bykov
- Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - E G Virshke
- Blokhin National Medical Research Center of Oncology, Moscow, Russia
| | - S A Gabriel
- Regional Clinical Hospital No. 2, Krasnodar, Russia
| | - D A Granov
- Granov Russian Research Center of Radiology and Surgical Technologies, St. Petersburg, Russia
| | - V V Darvin
- Surgut Regional Clinical Hospital, Surgut, Russia
| | - B I Dolgushin
- Blokhin National Medical Research Center of Oncology, Moscow, Russia
| | - T G Dyuzheva
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - M G Efanov
- Loginov Moscow Clinical Research Center, Moscow, Russia
| | - V L Korobka
- Rostov Regional Clinical Hospital, Rostov-On-Don, Russia
| | - M P Korolev
- St. Petersburg City Mariinskaya Hospital, St. Petersburg, Russia
| | - V V Kulabukhov
- Blokhin National Medical Research Center of Oncology, Moscow, Russia
| | | | - O V Melekhina
- Loginov Moscow Clinical Research Center, Moscow, Russia
| | | | | | | | - A A Polikarpov
- Granov Russian Research Center of Radiology and Surgical Technologies, St. Petersburg, Russia
| | - M I Prudkov
- Sverdlovsk Regional Clinical Hospital No. 1, Sverdlovsk, Russia
| | - V A Ratnikov
- Sokolov Clinical Hospital No. 122, St. Petersburg, Russia
| | - E N Solodinina
- Central Clinical Hospital with Polyclinic of the Presidential Administration, Moscow, Russia
| | - Yu A Stepanova
- Vishnevsky National Research Center of Surgery, Moscow, Russia
| | - V V Subbotin
- Loginov Moscow Clinical Research Center, Moscow, Russia
| | - E D Fedorov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A V Shabunin
- Botkin Municipal Clinical Hospital, Moscow, Russia
| | - S G Shapovalyants
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A M Shulutko
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - K V Shishin
- Loginov Moscow Clinical Research Center, Moscow, Russia
| | - V N Tsvirkun
- Loginov Moscow Clinical Research Center, Moscow, Russia
| | - A V Chzhao
- Vishnevsky National Research Center of Surgery, Moscow, Russia
| | | |
Collapse
|
9
|
The accuracy of 3T magnetic resonance cholangiopancreatography in suspected choledocholithiasis. Pol J Radiol 2019; 84:e419-e423. [PMID: 31969960 PMCID: PMC6964331 DOI: 10.5114/pjr.2019.89689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 09/23/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose The purpose of this study was to investigate interobserver agreement during magnetic resonance cholangio-pancreatography (MRCP) evaluation and the sensitivity and specificity of MRCP obtained with 3T scanners in cases of bile duct obstruction. Material and methods A total of 37 patients who had MRCP and endoscopic retrograde cholangiography (ERCP) were included. Choledochal pathology was divided into two groups regarding the presence of stones as "there is stone or not". MRCPs were performed with a 3-Tesla system using respiratory triggered HASTE technique in axial and coronal planes and with T2 SPACE sequence in the coronal plane. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated separately for each observer. The average of both observers was calculated for comparison with other studies. Results Thirty-seven patients were in the study population. Agreement between the observers was analysed, and Cohen's κ value was evaluated as 0.84. For two observers, the sensitivity of MRCP was 93%, whereas the specificity was 75% for the first observer and 62% for the second. Conclusions In this study we found a high level of interobserver agreement in evaluating MRCP. MRCP has a high sensitivity in detecting choledocholithiasis.
Collapse
|
10
|
Hall C, Regner JL, Schroeppel T, Rodriguez J, McIntyre R, Wright F, Dissanaike S, Richmond R, Santos A, Frazee RC. Protocol driven management of suspected common duct stones: A Southwestern Surgical Congress multi-centered trial. Am J Surg 2019; 218:1152-1155. [PMID: 31558305 DOI: 10.1016/j.amjsurg.2019.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 09/04/2019] [Accepted: 09/10/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Several options exist for the diagnosis and management of suspected common duct stones. We hypothesized that a protocol-directed approach would shorten length of stay in this patient population. METHODS Patients from four participating institutions with a peak bilirubin <4 mg/dL underwent surgery as the initial procedure, whereas patients with a bilirubin ≥4 mg/dL underwent endoscopy. The primary endpoint was length of stay. Analysis involved chi square and Wilcoxon-Mann-Whitney test with significance at p < 0.05. RESULTS 214 patients were managed under the protocol during six-month study period. 111 patients (52%) required endoscopy and surgery. Length of stay and the number of MRCPs performed pre-operatively significantly decreased following protocol implementation (p < 0.05). CONCLUSIONS "Surgery first" approach in patients with bilirubin <4 ml/dL resulted in low morbidity and mortality, reduced MRCP, and length of stay.
Collapse
Affiliation(s)
- Chad Hall
- Baylor Scott & White Health, Department of Surgery, Temple, TX, USA
| | - Justin L Regner
- Baylor Scott & White Health, Department of Surgery, Temple, TX, USA
| | | | - Joe Rodriguez
- UCHealth, Department of Surgery, Colorado Springs, CO, USA
| | - Robert McIntyre
- University of Colorado, Department of Surgery, Denver, CO, USA
| | - Franklin Wright
- University of Colorado, Department of Surgery, Denver, CO, USA
| | - Sharmila Dissanaike
- Texas Tech University Health Science Center, Department of Surgery, Lubbock, TX, USA
| | - Robyn Richmond
- Texas Tech University Health Science Center, Department of Surgery, Lubbock, TX, USA
| | - Ariel Santos
- Texas Tech University Health Science Center, Department of Surgery, Lubbock, TX, USA
| | - Richard C Frazee
- Baylor Scott & White Health, Department of Surgery, Temple, TX, USA.
| |
Collapse
|
11
|
Peponis T, Panda N, Eskesen TG, Forcione DG, Yeh DD, Saillant N, Kaafarani HM, King DR, de Moya MA, Velmahos GC, Fagenholz PJ. Preoperative endoscopic retrograde cholangio-pancreatography (ERCP) is a risk factor for surgical site infections after laparoscopic cholecystectomy. Am J Surg 2019; 218:140-144. [DOI: 10.1016/j.amjsurg.2018.09.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 09/14/2018] [Accepted: 09/24/2018] [Indexed: 12/27/2022]
|
12
|
Yu CY, Roth N, Jani N, Cho J, Van Dam J, Selby R, Buxbaum J. Dynamic liver test patterns do not predict bile duct stones. Surg Endosc 2019; 33:3300-3313. [PMID: 30911921 DOI: 10.1007/s00464-018-06620-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 12/04/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Numerous models have been developed to predict choledocholithiasis. Recent work has shown that these algorithms perform suboptimally. Identification of clinical predictors with high positive and negative predictive value would minimize adverse events associated with unnecessary diagnostic endoscopic retrograde cholangiopancreatography (ERCP) while limiting the use of expensive tests including magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS) for indeterminate cases. METHODS Consecutive unique inpatients who received their first ERCP at Los Angeles County Medical Center between January 2010 and November 2016 for suspected bile duct stones were reviewed. The primary outcome was the proportion of patients with specific combinations of liver enzyme patterns, transabdominal ultrasound, and clinical features who had stones confirmed on ERCP. As a secondary outcome, we assessed the performance of the American Society for Gastrointestinal Endoscopy (ASGE) risk stratification algorithm in our population. RESULTS Of the 604 included patients, bile duct stones were confirmed in 410 (67.9%). Detailed assessment of liver enzyme patterns alone and in combination with clinical features and imaging findings yielded no highly predictive algorithms. Additionally, the ASGE high-risk criterion had a positive predictive value of only 68% for stones. For the 236 patients for whom MRCP was performed, this imaging modality was shown to have highest predictive value for the presence of stones on ERCP. CONCLUSION Exhaustive exploration of various threshold values and dynamic patterns of liver enzymes combined with clinical features and basic imaging findings did not reveal an algorithm to accurately predict the presence of stones on ERCP. The ASGE risk stratification criteria were also insensitive in our population. Though desirable, there may be no "perfect" combination of clinical features that correlate with persistent bile duct stones. MRCP or EUS may be considered to avoid unnecessary ERCP and associated complications.
Collapse
Affiliation(s)
- Chung Yao Yu
- Department of Medicine, Keck School of Medicine, University of Southern California, D & T Building Room B4H100, 1983 Marengo St, Los Angeles, CA, 90033-1370, USA
| | - Nitzan Roth
- Department of Medicine, Keck School of Medicine, University of Southern California, D & T Building Room B4H100, 1983 Marengo St, Los Angeles, CA, 90033-1370, USA
| | - Niraj Jani
- Department of Medicine, Keck School of Medicine, University of Southern California, D & T Building Room B4H100, 1983 Marengo St, Los Angeles, CA, 90033-1370, USA
| | - Jaehoon Cho
- Department of Medicine, Keck School of Medicine, University of Southern California, D & T Building Room B4H100, 1983 Marengo St, Los Angeles, CA, 90033-1370, USA
| | - Jacques Van Dam
- Department of Medicine, Keck School of Medicine, University of Southern California, D & T Building Room B4H100, 1983 Marengo St, Los Angeles, CA, 90033-1370, USA
| | - Rick Selby
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - James Buxbaum
- Department of Medicine, Keck School of Medicine, University of Southern California, D & T Building Room B4H100, 1983 Marengo St, Los Angeles, CA, 90033-1370, USA.
| |
Collapse
|
13
|
Affiliation(s)
- Richard A. Kozarek
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, United States
| |
Collapse
|