ERCP for the detection of common bile duct stones

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ERCP for the detection of common bile duct stones

Preoperative selective ERCP is effective in detecting clinically

significant CBD stones, however, there is a high false-negative rate when a

single criterion is used to guide therapy, reports December's issue of

Endoscopy.

The detection and management of common bile duct (CBD) stones in patients

undergoing laparoscopic cholecystectomy continues to be controversial.

Several diagnostic and therapeutic strategies have been suggested.

These include intraoperative cholangiography, selective endoscopic

retrograde cholangiopancreatography (ERCP), magnetic resonance

cholangiopancreatography, and endoscopic ultrasonography.

Dr Katz and colleagues from , Australia undertook a study in order

to evaluate the efficacy of selective ERCP in detecting common bile duct stones

in patients with cholelithiasis before laparoscopic cholecystectomy.

The researchers carried out a prospective study including 427 patients

with cholelithiasis who presented during a 6-year period.

The research team assessed participants on a selective basis with ERCP for

suspected common bile duct stones before laparoscopic cholecystectomy.

The clinicians carried out ERCP if the patient had any of the following

criteria: a dilated common bile duct on ultrasound, gallstone pancreatitis, or

abnormal liver function tests.

Intraoperative cholangiography was not performed in any of the patients.

Long-term follow-up was undertaken.

On the basis of selective criteria, the clinicians performed ERCP on 41

patients with confirmed common bile duct stones in 22 cases.

The researchers found that the most useful predictor of CBD stones on ERCP

was the presence of a dilated common bile duct in association with abnormal

liver function tests.

The research team noted that in this situation, common bile duct stones

were identified in 14 of 17 cases.

Abnormal liver function tests alone had a sensitivity of 50 % (four of

eight). All other parameters used in isolation had a lower detection rate.

During a median follow-up period of 6 years, six of 386 patients with

initially normal imaging and biochemical tests presented again with retained

stones.

Clinicians successfully managed all cases by ERCP and sphincterotomy and

there were no major complications.

Dr Katz concluded, " Preoperative selective ERCP is effective in detecting

clinically significant CBD stones. "

" However, there is a high false-negative rate when a single criterion is

used to guide therapy. "

" Multivariate analysis of preoperative parameters for risk stratification,

in conjunction with other imaging modalities, may make it possible to minimize

unnecessary ERCPs. "

Endoscopy;2004; 36: 1045-1049

06 December 2004