Magnetic resonance cholangiopancreatography accurately detects common bile duct stones in resolving gallstone pancreatitis

Ali H. Hallal, Jose D. Amortegui, Igor M. Jeroukhimov, Victor Casillas, Carl I Schulman, Ronald J. Manning, Fahim A. Habib, Peter P. Lopez, Stephen M. Cohn, Danny Sleeman

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: There is controversy about the optimal method to detect common bile duct (CBD) stones in patients with mild resolving gallstone pancreatitis. The aim of this study was to evaluate magnetic resonance cholangiopancreatography (MRCP) in detecting choledocholithiasis in this group of patients. STUDY DESIGN: A prospective randomized trial was conducted. Patients randomized to group 1 (n = 34) underwent laparoscopic cholecystectomy (LC) and intraoperative cholangiography (IOC). Those randomized to group 2 (n = 29) had preoperative MRCP, of these, patients with negative MRCP underwent LC and IOC, patients with positive MRCP had preoperative ERCP followed by LC. RESULTS: Sixty-three patients were randomized (34 to group 1 and 29 to group 2). CBD stones were found in 5 patients in group 1. CBD exploration was performed in 2 patients, preoperative ERCP in 1, and postoperative ERCP in the other 2. MRCP showed CBD stones in 4 patients in group 2. There were two false-positive MRCPs. Four patients with a negative MRCP did not have IOC or ERCP, the remaining 21 patients with a negative MRCP had a negative IOC. The MRCP sensitivity was 100% (95% CI, 16-100%), specificity 91% (95% CI, 72-99%), positive predictive value 50% (95% CI, 7-93%), negative predictive value 100% (95% CI, 84-100%), and accuracy 92% (95% CI, 74-99%). CONCLUSIONS: Patients with resolving gallstone pancreatitis and a negative MRCP do not need preoperative ERCP or IOC. Only patients with a positive MRCP will require preoperative ERCP.

Original languageEnglish
Pages (from-to)869-875
Number of pages7
JournalJournal of the American College of Surgeons
Volume200
Issue number6
DOIs
StatePublished - Jun 1 2005

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Magnetic Resonance Cholangiopancreatography
Common Bile Duct
Gallstones
Pancreatitis
Endoscopic Retrograde Cholangiopancreatography
Cholangiography
Laparoscopic Cholecystectomy
Choledocholithiasis

ASJC Scopus subject areas

  • Surgery

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Magnetic resonance cholangiopancreatography accurately detects common bile duct stones in resolving gallstone pancreatitis. / Hallal, Ali H.; Amortegui, Jose D.; Jeroukhimov, Igor M.; Casillas, Victor; Schulman, Carl I; Manning, Ronald J.; Habib, Fahim A.; Lopez, Peter P.; Cohn, Stephen M.; Sleeman, Danny.

In: Journal of the American College of Surgeons, Vol. 200, No. 6, 01.06.2005, p. 869-875.

Research output: Contribution to journalArticle

Hallal, Ali H. ; Amortegui, Jose D. ; Jeroukhimov, Igor M. ; Casillas, Victor ; Schulman, Carl I ; Manning, Ronald J. ; Habib, Fahim A. ; Lopez, Peter P. ; Cohn, Stephen M. ; Sleeman, Danny. / Magnetic resonance cholangiopancreatography accurately detects common bile duct stones in resolving gallstone pancreatitis. In: Journal of the American College of Surgeons. 2005 ; Vol. 200, No. 6. pp. 869-875.
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abstract = "BACKGROUND: There is controversy about the optimal method to detect common bile duct (CBD) stones in patients with mild resolving gallstone pancreatitis. The aim of this study was to evaluate magnetic resonance cholangiopancreatography (MRCP) in detecting choledocholithiasis in this group of patients. STUDY DESIGN: A prospective randomized trial was conducted. Patients randomized to group 1 (n = 34) underwent laparoscopic cholecystectomy (LC) and intraoperative cholangiography (IOC). Those randomized to group 2 (n = 29) had preoperative MRCP, of these, patients with negative MRCP underwent LC and IOC, patients with positive MRCP had preoperative ERCP followed by LC. RESULTS: Sixty-three patients were randomized (34 to group 1 and 29 to group 2). CBD stones were found in 5 patients in group 1. CBD exploration was performed in 2 patients, preoperative ERCP in 1, and postoperative ERCP in the other 2. MRCP showed CBD stones in 4 patients in group 2. There were two false-positive MRCPs. Four patients with a negative MRCP did not have IOC or ERCP, the remaining 21 patients with a negative MRCP had a negative IOC. The MRCP sensitivity was 100{\%} (95{\%} CI, 16-100{\%}), specificity 91{\%} (95{\%} CI, 72-99{\%}), positive predictive value 50{\%} (95{\%} CI, 7-93{\%}), negative predictive value 100{\%} (95{\%} CI, 84-100{\%}), and accuracy 92{\%} (95{\%} CI, 74-99{\%}). CONCLUSIONS: Patients with resolving gallstone pancreatitis and a negative MRCP do not need preoperative ERCP or IOC. Only patients with a positive MRCP will require preoperative ERCP.",
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T1 - Magnetic resonance cholangiopancreatography accurately detects common bile duct stones in resolving gallstone pancreatitis

AU - Hallal, Ali H.

AU - Amortegui, Jose D.

AU - Jeroukhimov, Igor M.

AU - Casillas, Victor

AU - Schulman, Carl I

AU - Manning, Ronald J.

AU - Habib, Fahim A.

AU - Lopez, Peter P.

AU - Cohn, Stephen M.

AU - Sleeman, Danny

PY - 2005/6/1

Y1 - 2005/6/1

N2 - BACKGROUND: There is controversy about the optimal method to detect common bile duct (CBD) stones in patients with mild resolving gallstone pancreatitis. The aim of this study was to evaluate magnetic resonance cholangiopancreatography (MRCP) in detecting choledocholithiasis in this group of patients. STUDY DESIGN: A prospective randomized trial was conducted. Patients randomized to group 1 (n = 34) underwent laparoscopic cholecystectomy (LC) and intraoperative cholangiography (IOC). Those randomized to group 2 (n = 29) had preoperative MRCP, of these, patients with negative MRCP underwent LC and IOC, patients with positive MRCP had preoperative ERCP followed by LC. RESULTS: Sixty-three patients were randomized (34 to group 1 and 29 to group 2). CBD stones were found in 5 patients in group 1. CBD exploration was performed in 2 patients, preoperative ERCP in 1, and postoperative ERCP in the other 2. MRCP showed CBD stones in 4 patients in group 2. There were two false-positive MRCPs. Four patients with a negative MRCP did not have IOC or ERCP, the remaining 21 patients with a negative MRCP had a negative IOC. The MRCP sensitivity was 100% (95% CI, 16-100%), specificity 91% (95% CI, 72-99%), positive predictive value 50% (95% CI, 7-93%), negative predictive value 100% (95% CI, 84-100%), and accuracy 92% (95% CI, 74-99%). CONCLUSIONS: Patients with resolving gallstone pancreatitis and a negative MRCP do not need preoperative ERCP or IOC. Only patients with a positive MRCP will require preoperative ERCP.

AB - BACKGROUND: There is controversy about the optimal method to detect common bile duct (CBD) stones in patients with mild resolving gallstone pancreatitis. The aim of this study was to evaluate magnetic resonance cholangiopancreatography (MRCP) in detecting choledocholithiasis in this group of patients. STUDY DESIGN: A prospective randomized trial was conducted. Patients randomized to group 1 (n = 34) underwent laparoscopic cholecystectomy (LC) and intraoperative cholangiography (IOC). Those randomized to group 2 (n = 29) had preoperative MRCP, of these, patients with negative MRCP underwent LC and IOC, patients with positive MRCP had preoperative ERCP followed by LC. RESULTS: Sixty-three patients were randomized (34 to group 1 and 29 to group 2). CBD stones were found in 5 patients in group 1. CBD exploration was performed in 2 patients, preoperative ERCP in 1, and postoperative ERCP in the other 2. MRCP showed CBD stones in 4 patients in group 2. There were two false-positive MRCPs. Four patients with a negative MRCP did not have IOC or ERCP, the remaining 21 patients with a negative MRCP had a negative IOC. The MRCP sensitivity was 100% (95% CI, 16-100%), specificity 91% (95% CI, 72-99%), positive predictive value 50% (95% CI, 7-93%), negative predictive value 100% (95% CI, 84-100%), and accuracy 92% (95% CI, 74-99%). CONCLUSIONS: Patients with resolving gallstone pancreatitis and a negative MRCP do not need preoperative ERCP or IOC. Only patients with a positive MRCP will require preoperative ERCP.

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