There is controversy about the optimal method to detect common bile duct stones in patients with mild resolving gallstone pancreatitis.
Dr Sleeman and colleagues from Miami evaluated magnetic resonance cholangiopancreatography in detecting choledocholithiasis in this group of patients.
The investigative team conducted a prospective randomized trial including 63 patients.
|21 patients with negative magnetic resonance cholangiopancreatography had negative intraoperative cholangiography|
|American College of Surgeons|
The team randomized 34 patients to Group 1 who underwent laparoscopic cholecystectomy and intraoperative cholangiography.
The researchers reported that 29 randomized to Group 2 had preoperative magnetic resonance cholangiopancreatography.
Patients with negative magnetic resonance cholangiopancreatography underwent laparoscopic cholecystectomy and intraoperative cholangiography.
The researchers indicated that patients with positive magnetic resonance cholangiopancreatography had preoperative endoscopic retrograde cholangiopancreatography followed by laparoscopic cholecystectomy.
The team found common bile duct stones in 5 patients in Group 1.
The researchers performed common bile duct exploration was performed in 2 patients, preoperative endoscopic retrograde cholangiopancreatography in 1, and postoperative in the other 2.
Magnetic resonance cholangiopancreatography showed common bile duct stones in 4 patients in Group 2.
The investigators identified 2 false-positive magnetic resonance cholangiopancreatographies.
The team observed that 4 patients with a negative magnetic resonance cholangiopancreatography did not have intraoperative cholangiography or endoscopic retrograde cholangiopancreatography.
The researchers noted that 21 patients with a negative magnetic resonance cholangiopancreatography had a negative intraoperative cholangiography.
The magnetic resonance cholangiopancreatography sensitivity was 100%, specificity 91%, positive predictive value 50%, negative predictive value 100%, and accuracy 92%.
Dr Sleeman's team concludes, “Patients with resolving gallstone pancreatitis and a negative magnetic resonance cholangiopancreatography do not need preoperative endoscopic retrograde cholangiopancreatography or intraoperative cholangiography.”
“Only patients with a positive magnetic resonance cholangiopancreatography will require preoperative endoscopic retrograde cholangiopancreatography.”