Choledocholithiasis: An update on current evidence and practice
Main Article Content
Abstract
Introduction
Gallstone disease and its complications place a substantial burden on healthcare services, with common bile duct calculi having the potential to cause significant morbidity and mortality, particularly following the occurrence of ascending cholangitis or pancreatitis. Due to these potential risks it is important, when present, to accurately identify common bile duct calculi in patients with gallstone disease. There are a number of investigations available to aid clinicians in the identification of choledocholithiasis. The aim of this review is to evaluate the current evidence and the up-to-date practice within western populations.
Methods
A literature review was performed using the Medline database.
Conclusion
The reliability of trans-abdominal ultrasound scans and liver function tests in accurately identifying common bile duct calculi were found to be poor. Risk stratification using algorithms incorporating both tests, together with clinical factors, were also found to be inadequate for accurately predicting choledocholithiasis. Based on initial screening further assessment in intermediate and high-risk groups is suggested to avoid unnecessary invasive investigations and therapeutic procedures, which themselves are associated with a significant rate of complications.
Article Details
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
2. Buyukasik K, Toros AB, Bektas H, Ari A, Deniz MM. Diagnostic and therapeutic value of ERCP in acute cholangitis. ISRN Gastroenterol. 2013;2013:191729. doi:10.1155/2013/191729.
3. Toh SK, Phillips S, Johnson CD. A prospective audit against national standards of the presentation and management of acute pancreatitis in the South of England. Gut. 2000;46(2):239-43.
4. ASGE Standards of Practice Committee, Maple JT, Ikenberry SO, et al. The role of endoscopy in the management of choledocholithiasis. Gastrointest Endosc. 2011;74(4):731-44. doi:10.1016/j.gie.2011.04.012.
5. ASGE Standards of Practice Committee, Maple JT, Ben-Menachem T, et al. The role of endoscopy in the evaluation of suspected choledocholithiasis. Gastrointest Endosc. 2010;71(1):1-9. doi:10.1016/j.gie.2009.09.041.
6. Verma D, Kapadia A, Eisen GM, Adler DG. EUS vs MRCP for detection of choledocholithiasis. Gastrointest Endosc. 2006;64(2):248-254. doi:10.1016/j.gie.2005.12.038.
7. Giljaca V, Gurusamy KS, Takwoingi Y, et al. Endoscopic ultrasound versus magnetic resonance cholangiopancreatography for common bile duct stones. Cochrane database Syst Rev. 2015;(2):CD011549. doi:10.1002/14651858.CD011549.
8. Gurusamy KS, Giljaca V, Takwoingi Y, et al. Ultrasound versus liver function tests for diagnosis of common bile duct stones. Cochrane database Syst Rev. 2015;(2):CD011548. doi:10.1002/14651858.CD011548.
9. Isherwood J, Garcea G, Williams R, Metcalfe M, Dennison a R. Serology and ultrasound for diagnosis of choledocholithiasis. Ann R Coll Surg Engl. 2014;96(3):224-8. doi:10.1308/003588414X13814021678033.
10. Ahn KS, Yoon Y-S, Han H-S, Cho JY. Use of Liver Function Tests as First-line Diagnostic Tools for Predicting Common Bile Duct Stones in Acute Cholecystitis Patients. World J Surg. 2016;40(8):1925-31. doi:10.1007/s00268-016-3517-y.
11. Boys JA, Doorly MG, Zehetner J, Dhanireddy KK, Senagore AJ. Can ultrasound common bile duct diameter predict common bile duct stones in the setting of acute cholecystitis? Am J Surg. 2014;207(3):432-435. doi:10.1016/j.amjsurg.2013.10.014.
12. Qiu Y, Yang Z, Li Z, Zhang W, Xue D. Is preoperative MRCP necessary for patients with gallstones? An analysis of the factors related to missed diagnosis of choledocholithiasis by preoperative ultrasound. BMC Gastroenterol. 2015;15. doi:10.1186/s12876-015-0392-1.
13. Rubin MIN, Thosani NC, Tanikella R, Wolf DS, Fallon MB, Lukens FJ. Endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis: Testing the current guidelines. Dig Liver Dis. 2013;45(9):744-749. doi:10.1016/j.dld.2013.02.005.
14. Magalhães J, Rosa B, Cotter J. Endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis: From guidelines to clinical practice. World J Gastrointest Endosc. 2015;7(2):128-34. doi:10.4253/wjge.v7.i2.128.
15. Prachayakul V, Aswakul P, Bhunthumkomol P, Deesomsak M. Diagnostic yield of endoscopic ultrasonography in patients with intermediate or high likelihood of choledocholithiasis: a retrospective study from one university-based endoscopy center. BMC Gastroenterol. 2014;14:165. doi:10.1186/1471-230X-14-165.
16. Nárvaez Rivera RM, González González JA, Monreal Robles R, et al. Accuracy of ASGE criteria for the prediction of choledocholithiasis. Rev Española Enfermedades Dig. 2016;108(6):309-14. doi:10.17235/reed.2016.4212/2016.
17. Anand G, Patel YA, Yeh H-C, et al. Factors and Outcomes Associated with MRCP Use prior to ERCP in Patients at High Risk for Choledocholithiasis. Can J Gastroenterol Hepatol. 2016;2016:1-6. doi:10.1155/2016/5132052.
18. Gurusamy KS, Giljaca V, Takwoingi Y, et al. Endoscopic retrograde cholangiopancreatography versus intraoperative cholangiography for diagnosis of common bile duct stones. In: Gurusamy KS, ed. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2015. doi:10.1002/14651858.CD010339.pub2.