Choledocholithiasis - The Eastern Association for the Surgery of Trauma

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Eastern Association for the Surgery of Trauma

Choledocholithiasis

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Protocol driven management of suspected common duct stones: A Southwestern Surgical Congress multi-centered trial.

Hall C, Regner JL, Schroeppel T, Rodriguez J, McIntyre R, Wright F, Dissanaike S, Richmond R, Santos A, Frazee RC.

The American Journal of Surgery. 2019 Dec 1;218(6):1152-5.

Rationale for Inclusion: This study followed up a multi centertrial on the current practice in the preop evaluation for choledocholithiasis, demonstrating a wide practice variation in imaging and timing of surgery. Four centers then prospectively followed a algorithm utilizing a Bilirubin of four as a cut off for surgery or additional investigation (MRCP or ERCP). This protocol was found to be safe, with a low morbidity and mortality. It also reduced length of stay and number of MRCP's. The authors also demonstrated a low rate of missed choledocholithiasis requiring intervention.

CAVEAT: The study demonstrated a high rate of IOC. For surgeons that do not routinely perform this procedure, this algorithm may not be generizable and further study is needed.

Citations - To review the number of citations for this landmark paper, visit Google Scholar.

Inpatient Choledocholithiasis Requiring ERCP and Cholecystectomy: Outcomes of a Combined Single Inpatient Procedure Versus Separate-Session Procedures.

Passi M, Inamdar S, Hersch D, Dowling O, Sejpal DV, Trindade AJ.

J Gastrointest Surg. 2018 Mar;22(3):451-459

Rationale for inclusion: This study demonstrates that a single operative session is safe, efficacious, and has a decrease in cost compared to separate session and hospitalizations.

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Laparoscopic common bile duct exploration versus endoscopic retrograde cholangiopancreatography for choledocholithiasis found at time of laparoscopic cholecystectomy: Analysis of a large integrated health care system database.

Al-Temimi MH, Kim EG, Chandrasekaran B, Franz V, Trujillo CN, Mousa A, Tessier DJ, Johna SD, Santos DA.

Am J Surg. 2017 Dec;214(6):1075-1079

Rationale for inclusion: This multicenter, community hospital-based retrospective study provides the current trend to favor ERCP vs laparoscopic /open common bile duct exploration in the removal of choledolithiasis. ERCP in this study has a higher clearance rate with an associated higher number of interventions per patient.

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Severe elevation of liver test in choledocholithiasis. An uncommon occurrence with important clinical implications.

Bangaru S, Thiele D, Sreenarasimhaiah J, Agrawal D.

J Clin Gastroenterol. 2017 Sep;51(8):728-733.

Rationale for inclusion: Awareness of this low prevalence condition can decrease unnecessary laboratory and images, thereby reducing healthcare cost.

Citations - To review the number of citations for this landmark paper, visit Google Scholar.

Recurrence of choledocholithiasis following endoscopic bile duct clearance: Long term results and factors associated with recurrent bile duct stones.

Konstantakis C, Triantos C, Theopistos V, Theocharis G, Maroulis I, Diamantopoulou G, Thomopoulos K.

World J Gastrointest Endosc. 2017 Jan 16;9(1):26-33.

Rationale for inclusion: This study describes some risk factors for recurrence of biliary obstruction even after ERCP.

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Nationwide Assessment of Trends in Choledocholithiasis Management in the United States From 1998 to 2013.

Wandling MW, Hungness ES, Pavey ES, Stulberg JJ, Schwab B, Yang AD, Shapiro MB, Bilimoria KY, Ko CY, Nathens AB.

JAMA Surg. 2016 Dec 1;151(12):1125-1130.

Rationale for inclusion: This longitudinal analysis of the National Inpatient Sample from 1998 to 2013 confirms the decreasing role of common bile duct exploration (particularly via the open approach) concomitant with the increasing utilization of ERCP for CBD clearance. While a shorter median hospital LOS was seen with laparoscopic CBE compared to ERCP, the difference was small (0.5 days) and of questionable clinical significance.

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An analysis of omitting biliary tract imaging in 668 subjects admitted to an acute care surgery service with biochemical evidence of choledocholithiasis.

Riggle AJ, Cripps MW, Liu L, Subramanian M, Nakonezny PA, Wolf SE, Phelan HA.

Am J Surg. 2015 Dec;210(6):1140-4; discussion 1144-6.

Rationale for inclusion: This large study contradicts the traditional teaching that patients presenting with biochemical evidence of choledocholithiasis require preoperative or intraoperative biliary imaging. The findings are encouraging because they report a low rate of adverse outcomes. Additional studies are required to confirm these findings.

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Initial Cholecystectomy with Cholangiography Decreases Length of Stay Compared to Preoperative MRCP or ERCP in the Management of Choledocholithiasis.

Lin C, Collins JN, Britt RC, Britt LD.

Am Surg. 2015 Jul;81(7):726-31.

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Rationale for inclusion: This study demonstrates that a strategy of initial laparoscopic cholecystectomy with intraoperative cholangiogram (IOC) is associated with a shorter hospital stay compared to preoperative MRCP or ERCP.

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Use of magnetic resonance cholangiopancreatography in clinical practice: not as good as we once thought.

Aydelotte JD, Ali J, Huynh PT, Coopwood TB, Uecker JM, Brown CV.

J Am Coll Surg. 2015 Jul;221(1):215-9.

Rationale for inclusion: another study demonstrating the inaccuracy of MRCP.

Citations - To review the number of citations for this landmark paper, visit Google Scholar.

Initial cholecystectomy vs sequential common duct endoscopic assessment and subsequent cholecystectomy for suspected gallstone migration: a randomized clinical trial.

Iranmanesh P, Frossard JL, Mugnier-Konrad B, Morel P, Majno P, Nguyen-Tang T, Berney T, Mentha G, Toso C.

JAMA. 2014 Jul;312(2):137-44.

Rationale for inclusion: this RCT favors initial cholecystectomy with IOC over initial ERCP followed by cholecystectomy for patients with intermediate (total bilirubin < 4.0) risk of choledocholithiasis.

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Diagnostic accuracy of magnetic resonance cholangiopancreatography and ultrasound compared with direct cholangiography in the detection of choledocholithiasis.

Varghese JC, Liddell RP, Farrell MA, Murray FE, Osborne DH, Lee MJ.

Clin Radiol. 2000 Jan;55(1):25-35.

Rationale for inclusion: in contrast, this study reports high accuracy of MRCP for the diagnosis of choledocholithiasis.

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Diagnosis of choledocholithiasis: EUS or magnetic resonance cholangiography? A prospective controlled study.

de Lédinghen V, Lecesne R, Raymond JM, Gense V, Amouretti M, Drouillard J, Couzigou P, Silvain C.

Gastrointest Endosc. 1999 Jan;49(1):26-31.

Rationale for inclusion: this study supports the accuracy of EUS for the diagnosis of choledocholithiasis.

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Use of magnetic resonance cholangiography in the diagnosis of choledocholithiasis: prospective comparison with a reference imaging method.

Zidi SH, Prat F, Le Guen O, Rondeau Y, Rocher L, Fritsch J, Choury AD, Pelletier G.

Gut. 1999 Jan;44(1):118-22.

Rationale for inclusion: this study also suggests poor accuracy of MRCP for the diagnosis of choledocholithiasis.

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Endoscopic ultrasonography versus cholangiography for the diagnosis of choledocholithiasis.

Canto MI, Chak A, Stellato T, Sivak MV Jr.

Gastrointest Endosc. 1998 Jun;47(6):439-48.

Rationale for inclusion: this study supports the accuracy of EUS for the diagnosis of choledocholithiasis.

Citations - To review the number of citations for this landmark paper, visit Google Scholar.

Predictive factors for synchronous common bile duct stones in patients with cholelithiasis.

Alponat A, Kum CK, Rajnakova A, Koh BC, Goh PM.

Surg Endosc. 1997 Sep;11(9):928-32.

Rationale for inclusion: This study describes offers four clinical/laboratory/sonographic signs which may help predict the likelihood of having CBD stones.

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Endoscopic ultrasonography for diagnosing choledocholithiasis: a prospective comparative study with ultrasonography and computed tomography.

Sugiyama M, Atomi Y.

Gastrointest Endosc. 1997 Feb;45(2):143-6.

Rationale for inclusion: this study supports the accuracy of EUS for the diagnosis of choledocholithiasis.

Citations - To review the number of citations for this landmark paper, visit Google Scholar.

Diagnosis of choledocholithiasis by endoscopic ultrasonography.

Amouyal P, Amouyal G, Lévy P, Tuzet S, Palazzo L, Vilgrain V, Gayet B, Belghiti J, Fékété F, Bernades P.

Gastroenterology. 1994 Apr;106(4):1062-7.

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Rationale for inclusion: another study supporting EUS for the diagnosis of choledocholithiasis.

Citations - To review the number of citations for this landmark paper, visit Google Scholar.