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How reliable is intraoperative cholangiography as a method for detecting common bile duct stones?

A prospective population-based study on 1171 patients

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Abstract

Background

Although intraoperative cholangiography (IOC) is a widely used method for detecting common bile duct stones (CBDS), its accuracy has not been fully evaluated in large nonselected patient samples. The purpose of this study was to assess the sensitivity, specificity and predictive value of dynamic IOC regarding its ability to diagnose CBDS in a population-based setting, and to assess the morbidity associated with the investigation.

Methods

All patients operated on for gallstone disease between 2003 and 2005 in the county of Uppsala in Sweden, a county with a population of 302,000 in December 2004, were registered prospectively. The outcome of cholangiography was validated against the postoperative clinical course.

Results

1171 patients were registered, and among these IOC was performed in 1117 patients (95%). Common bile duct stones were found in 134 patients (11%). One perforation of the common bile duct caused by the IOC catheter was recorded. Sensitivity was 97%, specificity 99%, negative predictive value 99%, positive predictive value 95%, and overall accuracy 99%. In 7 of the 134 cases where IOC indicated CBDS, no stones could be verified on exploration. In 4 of the 979 cases where IOC was normal, the clinical course indicated overlooked CBDS.

Conclusion

Intraoperative cholangiography is a safe and accurate method for detecting common bile duct stones.

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Fig. 1

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Abbreviations

CBD:

Common bile duct

CBDS:

Common bile duct stones

IOC:

Intraoperative cholangiography

MRI:

Magnetic resonance imaging

ERCP:

Endoscopic retrograde cholangiopancreatography

PTC:

Percutaneous transhepatic cholangiography

MRCP:

Magnetic resonance cholangiopancreatography

ALP:

Alkaline phosphatase

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Authors and Affiliations

  1. Centre of Gastrointestinal Diseases, Department of Surgery, Ersta Hospital, 116 91, Stockholm, Sweden

    Per Videhult

  2. Department of Surgery, Uppsala University Hospital, 751 85, Uppsala, Sweden

    Gabriel Sandblom & Ib Christian Rasmussen

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  1. Per Videhult
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  2. Gabriel Sandblom
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  3. Ib Christian Rasmussen
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Correspondence to Per Videhult.

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Videhult, P., Sandblom, G. & Rasmussen, I.C. How reliable is intraoperative cholangiography as a method for detecting common bile duct stones?. Surg Endosc 23, 304–312 (2009). https://doi.org/10.1007/s00464-008-9883-2

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  • DOI: https://doi.org/10.1007/s00464-008-9883-2

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