Noninvasive evaluation of patients with suspected choledocholithiasis

Information obtained during the initial noninvasive evaluation of patients with cholelithiasis can accurately assess the probability of choledocholithiasis, according to research published in July's Annals of Surgery.

A team from Houston, Texas, assessed the use of magnetic resonance cholangiography (MRC) and endoscopic retrograde cholangiopancreatography (ERCP) before laparoscopic cholecystectomy (LC).

Patients investigated presented with cholelithiasis and suspected choledocholithiasis.

During a 16-month period, the authors prospectively evaluated 440 patients, before laparoscopic cholecystectomy, using triage guidelines. Patient information obtained from clinical evaluation, serum chemistry analysis, and abdominal ultrasonography was incorporated.

The 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 the 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.

MRC was used for 8.4% (37/440) of patients.

Triage guidelines for choledocholithiasis facilitate patient management.

Annals of Surgery

The researchers found that 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 6 patients (1.4%).

Dr Terrence H. Liu, of the University of Texas-Houston Medical School and Lyndon B. Johnson General Hospital, said on behalf of fellow authors, "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," he concluded.