Patient evaluation and management with selective use of magnetic resonance cholangiography and endoscopic retrograde cholangiopancreatography before laparoscopic cholecystectomy
To assess the utility of triage guidelines for patients with cholelithiasis and suspected choledocholithiasis, incorporating selective use of magnetic resonance cholangiography (MRC) and endoscopic retrograde cholangiopancreatography (ERCP) before laparoscopic cholecystectomy (LC). ERCP is the most...
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| Veröffentlicht in: | Annals of surgery 2001-07, Vol.234 (1), p.33-40 |
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| creator | LIU, Terrence H CONSORTI, Eileen T KAWASHIMA, Akira TAMM, Eric P KWONG, Karen L GILL, Brijesh S SELLIN, Joseph H PEDEN, Eric K MERCER, David W |
| description | To assess the utility of triage guidelines for patients with cholelithiasis and suspected choledocholithiasis, incorporating selective use of magnetic resonance cholangiography (MRC) and endoscopic retrograde cholangiopancreatography (ERCP) before laparoscopic cholecystectomy (LC).
ERCP is the most frequently used modality for the diagnosis and resolution of choledocholithiasis before LC. MRC has recently emerged as an accurate, noninvasive modality for the detection of choledocholithiasis. However, useful strategies for implementing this diagnostic modality for patient evaluation before LC have not been investigated.
During a 16-month period, the authors prospectively evaluated all patients before LC using triage guidelines incorporating patient information obtained from clinical evaluation, serum chemistry analysis, and abdominal ultrasonography. Patients were then assigned to one of four groups based on the level of suspicion for choledocholithiasis (group I, extremely high; group 2, high; group 3, moderate; group 4, low). Group 1 patients underwent ERCP and clearance of common bile duct stones; group 2 patients underwent MRC; group 3 patients underwent LC with intraoperative cholangiography; and group 4 patients underwent LC without intraoperative cholangiography.
Choledocholithiasis was detected in 43 of 440 patients (9.8%). The occurrence of choledocholithiasis among patients in the four groups were 92.6% (25/27), 32.4% (12/37), 3.8% (2/52), and 0.9% (3/324) for groups 1, 2, 3, and 4, respectively (P |
| doi_str_mv | 10.1097/00000658-200107000-00006 |
| format | Article |
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ERCP is the most frequently used modality for the diagnosis and resolution of choledocholithiasis before LC. MRC has recently emerged as an accurate, noninvasive modality for the detection of choledocholithiasis. However, useful strategies for implementing this diagnostic modality for patient evaluation before LC have not been investigated.
During a 16-month period, the authors prospectively evaluated all patients before LC using triage guidelines incorporating patient information obtained from clinical evaluation, serum chemistry analysis, and abdominal ultrasonography. Patients were then assigned to one of four groups based on the level of suspicion for choledocholithiasis (group I, extremely high; group 2, high; group 3, moderate; group 4, low). Group 1 patients underwent ERCP and clearance of common bile duct stones; group 2 patients underwent MRC; group 3 patients underwent LC with intraoperative cholangiography; and group 4 patients underwent LC without intraoperative cholangiography.
Choledocholithiasis was detected in 43 of 440 patients (9.8%). The occurrence of choledocholithiasis among patients in the four groups were 92.6% (25/27), 32.4% (12/37), 3.8% (2/52), and 0.9% (3/324) for groups 1, 2, 3, and 4, respectively (P <.001). MRC was used for 8.4% (37/440) of patients. Patient triage resulted in the identification of common bile duct stones during preoperative ERCP in 92.3% (36/39) of the patients. Unsuspected common bile duct stones occurred in six patients (1.4%).
The probability of choledocholithiasis can be accurately assessed based on information obtained during the initial noninvasive evaluation. Stratification of risks for choledocholithiasis facilitates patient management with the most appropriate diagnostic studies and interventions, thereby improving patient care and resource utilization.</description><identifier>ISSN: 0003-4932</identifier><identifier>EISSN: 1528-1140</identifier><identifier>DOI: 10.1097/00000658-200107000-00006</identifier><identifier>PMID: 11420481</identifier><identifier>CODEN: ANSUA5</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott</publisher><subject>Algorithms ; Amylases - blood ; Biological and medical sciences ; Cholangiography - methods ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy, Laparoscopic ; Gallstones - diagnostic imaging ; Humans ; Intraoperative Period ; Liver Function Tests ; Liver, biliary tract, pancreas, portal circulation, spleen ; Magnetic Resonance Imaging ; Medical sciences ; Original ; Patient Selection ; Prospective Studies ; Risk Assessment ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the digestive system</subject><ispartof>Annals of surgery, 2001-07, Vol.234 (1), p.33-40</ispartof><rights>2001 INIST-CNRS</rights><rights>2001 Lippincott Williams & Wilkins, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c445t-b5231911f540c138d59afe4cd7dc692e4c103bc3f7cdb816e2fe2b514b7c71be3</citedby><cites>FETCH-LOGICAL-c445t-b5231911f540c138d59afe4cd7dc692e4c103bc3f7cdb816e2fe2b514b7c71be3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1421945/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1421945/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1066303$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11420481$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>LIU, Terrence H</creatorcontrib><creatorcontrib>CONSORTI, Eileen T</creatorcontrib><creatorcontrib>KAWASHIMA, Akira</creatorcontrib><creatorcontrib>TAMM, Eric P</creatorcontrib><creatorcontrib>KWONG, Karen L</creatorcontrib><creatorcontrib>GILL, Brijesh S</creatorcontrib><creatorcontrib>SELLIN, Joseph H</creatorcontrib><creatorcontrib>PEDEN, Eric K</creatorcontrib><creatorcontrib>MERCER, David W</creatorcontrib><title>Patient evaluation and management with selective use of magnetic resonance cholangiography and endoscopic retrograde cholangiopancreatography before laparoscopic cholecystectomy</title><title>Annals of surgery</title><addtitle>Ann Surg</addtitle><description>To assess the utility of triage guidelines for patients with cholelithiasis and suspected choledocholithiasis, incorporating selective use of magnetic resonance cholangiography (MRC) and endoscopic retrograde cholangiopancreatography (ERCP) before laparoscopic cholecystectomy (LC).
ERCP is the most frequently used modality for the diagnosis and resolution of choledocholithiasis before LC. MRC has recently emerged as an accurate, noninvasive modality for the detection of choledocholithiasis. However, useful strategies for implementing this diagnostic modality for patient evaluation before LC have not been investigated.
During a 16-month period, the authors prospectively evaluated all patients before LC using triage guidelines incorporating patient information obtained from clinical evaluation, serum chemistry analysis, and abdominal ultrasonography. Patients were then assigned to one of four groups based on the level of suspicion for choledocholithiasis (group I, extremely high; group 2, high; group 3, moderate; group 4, low). Group 1 patients underwent ERCP and clearance of common bile duct stones; group 2 patients underwent MRC; group 3 patients underwent LC with intraoperative cholangiography; and group 4 patients underwent LC without intraoperative cholangiography.
Choledocholithiasis was detected in 43 of 440 patients (9.8%). The occurrence of choledocholithiasis among patients in the four groups were 92.6% (25/27), 32.4% (12/37), 3.8% (2/52), and 0.9% (3/324) for groups 1, 2, 3, and 4, respectively (P <.001). MRC was used for 8.4% (37/440) of patients. Patient triage resulted in the identification of common bile duct stones during preoperative ERCP in 92.3% (36/39) of the patients. Unsuspected common bile duct stones occurred in six patients (1.4%).
The probability of choledocholithiasis can be accurately assessed based on information obtained during the initial noninvasive evaluation. Stratification of risks for choledocholithiasis facilitates patient management with the most appropriate diagnostic studies and interventions, thereby improving patient care and resource utilization.</description><subject>Algorithms</subject><subject>Amylases - blood</subject><subject>Biological and medical sciences</subject><subject>Cholangiography - methods</subject><subject>Cholangiopancreatography, Endoscopic Retrograde</subject><subject>Cholecystectomy, Laparoscopic</subject><subject>Gallstones - diagnostic imaging</subject><subject>Humans</subject><subject>Intraoperative Period</subject><subject>Liver Function Tests</subject><subject>Liver, biliary tract, pancreas, portal circulation, spleen</subject><subject>Magnetic Resonance Imaging</subject><subject>Medical sciences</subject><subject>Original</subject><subject>Patient Selection</subject><subject>Prospective Studies</subject><subject>Risk Assessment</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the digestive system</subject><issn>0003-4932</issn><issn>1528-1140</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkc9u1DAQxi0EokvhFZAPiFuKHTv_LkioAopUqRzas-U4k6xRYgfbWbSPxRsy2e6WrS-2Z37fjD0fIZSzK86a6hNbV1nUWc4YZxVeskPkBdnwIq8zziV7STYYEplsRH5B3sT4C1lZs-o1ucB8zmTNN-TvT50suERhp8cFz95R7To6aacHmNbMH5u2NMIIJtkd0CUC9T0Cg4NkDQ0QvdPOADVbP2o3WD8EPW_3hzrgOh-Nnw9gCmuqOyNnFAbQ6SRpofcB6KhnHU66FQazjwkf4Kf9W_Kq12OEd8f9kjx8-3p_fZPd3n3_cf3lNjNSFilri1zwhvO-kMxwUXdFo3uQpqs6UzY5njgTrRF9Zbq25iXkPeRtwWVbmYq3IC7J58e689JO0BkcRdCjmoOddNgrr616nnF2qwa_Uzhb3sgCC3w8Fgj-9wIxqclGAyP-HPwSVcUa0aB7CNaPoME_xwD9UxPO1Oq3Ovmtnvw-hEqUvj9_5H_h0WAEPhwBHY0e-4ADt_GsQVkKJsQ_BmW7AA</recordid><startdate>20010701</startdate><enddate>20010701</enddate><creator>LIU, Terrence H</creator><creator>CONSORTI, Eileen T</creator><creator>KAWASHIMA, Akira</creator><creator>TAMM, Eric P</creator><creator>KWONG, Karen L</creator><creator>GILL, Brijesh S</creator><creator>SELLIN, Joseph H</creator><creator>PEDEN, Eric K</creator><creator>MERCER, David W</creator><general>Lippincott</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20010701</creationdate><title>Patient evaluation and management with selective use of magnetic resonance cholangiography and endoscopic retrograde cholangiopancreatography before laparoscopic cholecystectomy</title><author>LIU, Terrence H ; CONSORTI, Eileen T ; KAWASHIMA, Akira ; TAMM, Eric P ; KWONG, Karen L ; GILL, Brijesh S ; SELLIN, Joseph H ; PEDEN, Eric K ; MERCER, David W</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c445t-b5231911f540c138d59afe4cd7dc692e4c103bc3f7cdb816e2fe2b514b7c71be3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>Algorithms</topic><topic>Amylases - blood</topic><topic>Biological and medical sciences</topic><topic>Cholangiography - methods</topic><topic>Cholangiopancreatography, Endoscopic Retrograde</topic><topic>Cholecystectomy, Laparoscopic</topic><topic>Gallstones - diagnostic imaging</topic><topic>Humans</topic><topic>Intraoperative Period</topic><topic>Liver Function Tests</topic><topic>Liver, biliary tract, pancreas, portal circulation, spleen</topic><topic>Magnetic Resonance Imaging</topic><topic>Medical sciences</topic><topic>Original</topic><topic>Patient Selection</topic><topic>Prospective Studies</topic><topic>Risk Assessment</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the digestive system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>LIU, Terrence H</creatorcontrib><creatorcontrib>CONSORTI, Eileen T</creatorcontrib><creatorcontrib>KAWASHIMA, Akira</creatorcontrib><creatorcontrib>TAMM, Eric P</creatorcontrib><creatorcontrib>KWONG, Karen L</creatorcontrib><creatorcontrib>GILL, Brijesh S</creatorcontrib><creatorcontrib>SELLIN, Joseph H</creatorcontrib><creatorcontrib>PEDEN, Eric K</creatorcontrib><creatorcontrib>MERCER, David W</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Annals of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>LIU, Terrence H</au><au>CONSORTI, Eileen T</au><au>KAWASHIMA, Akira</au><au>TAMM, Eric P</au><au>KWONG, Karen L</au><au>GILL, Brijesh S</au><au>SELLIN, Joseph H</au><au>PEDEN, Eric K</au><au>MERCER, David W</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Patient evaluation and management with selective use of magnetic resonance cholangiography and endoscopic retrograde cholangiopancreatography before laparoscopic cholecystectomy</atitle><jtitle>Annals of surgery</jtitle><addtitle>Ann Surg</addtitle><date>2001-07-01</date><risdate>2001</risdate><volume>234</volume><issue>1</issue><spage>33</spage><epage>40</epage><pages>33-40</pages><issn>0003-4932</issn><eissn>1528-1140</eissn><coden>ANSUA5</coden><abstract>To assess the utility of triage guidelines for patients with cholelithiasis and suspected choledocholithiasis, incorporating selective use of magnetic resonance cholangiography (MRC) and endoscopic retrograde cholangiopancreatography (ERCP) before laparoscopic cholecystectomy (LC).
ERCP is the most frequently used modality for the diagnosis and resolution of choledocholithiasis before LC. MRC has recently emerged as an accurate, noninvasive modality for the detection of choledocholithiasis. However, useful strategies for implementing this diagnostic modality for patient evaluation before LC have not been investigated.
During a 16-month period, the authors prospectively evaluated all patients before LC using triage guidelines incorporating patient information obtained from clinical evaluation, serum chemistry analysis, and abdominal ultrasonography. Patients were then assigned to one of four groups based on the level of suspicion for choledocholithiasis (group I, extremely high; group 2, high; group 3, moderate; group 4, low). Group 1 patients underwent ERCP and clearance of common bile duct stones; group 2 patients underwent MRC; group 3 patients underwent LC with intraoperative cholangiography; and group 4 patients underwent LC without intraoperative cholangiography.
Choledocholithiasis was detected in 43 of 440 patients (9.8%). The occurrence of choledocholithiasis among patients in the four groups were 92.6% (25/27), 32.4% (12/37), 3.8% (2/52), and 0.9% (3/324) for groups 1, 2, 3, and 4, respectively (P <.001). MRC was used for 8.4% (37/440) of patients. Patient triage resulted in the identification of common bile duct stones during preoperative ERCP in 92.3% (36/39) of the patients. Unsuspected common bile duct stones occurred in six patients (1.4%).
The probability of choledocholithiasis can be accurately assessed based on information obtained during the initial noninvasive evaluation. Stratification of risks for choledocholithiasis facilitates patient management with the most appropriate diagnostic studies and interventions, thereby improving patient care and resource utilization.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott</pub><pmid>11420481</pmid><doi>10.1097/00000658-200107000-00006</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Annals of surgery, 2001-07, Vol.234 (1), p.33-40 |
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| source | MEDLINE; EZB-FREE-00999 freely available EZB journals; PubMed Central; Journals@Ovid Complete |
| subjects | Algorithms Amylases - blood Biological and medical sciences Cholangiography - methods Cholangiopancreatography, Endoscopic Retrograde Cholecystectomy, Laparoscopic Gallstones - diagnostic imaging Humans Intraoperative Period Liver Function Tests Liver, biliary tract, pancreas, portal circulation, spleen Magnetic Resonance Imaging Medical sciences Original Patient Selection Prospective Studies Risk Assessment Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the digestive system |
| title | Patient evaluation and management with selective use of magnetic resonance cholangiography and endoscopic retrograde cholangiopancreatography before laparoscopic cholecystectomy |
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