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Scripta Scientifica Medica

ERCP and intraoperative laparoscopic cholangiography in the management of bile ducts stones - is there an alternative in the face of MRCP

Valentin Ignatov, Krasimir Ivanov, Nikola Kolev, Anton Tonev, M. Novakova, R. Georgiev

Abstract

Background: It is controversial whether selective endoscopic sphincterotomy or routine laparoscopic bileduct exploration is the optimal treatment for choledocholithiasis. Magnetic resonance cholangio-pancreatography (MRCP) is a safe and accurate imaging modality; this study evaluated its use in a clinical algorithm for the man agement of suspected choledocholithiasis.

Patients and methods: Consecutive patients presenting with suspected common bile duct (CBD) stones were managed according to an algorithm involving the selective use of MRCP to identify patients who required endoscopic sphincterotomy and bile ductclear ance. Follow ingra diological demonstration оf a clear CBD, all patients were considered for cholecystectomy.

Results: From 157 consecutive patients, 68 proceeded straight to endoscopic sphincterotomy, which was therapeutic in 59. Of 3 who underwent MRCP, choledocholithiasis or tumor obstruction was demonstrated; subsequent endoscopic sphincterotomy was therapeutic. Seventy-four patients subsequently underwent cholecystectomy, with a conversion rate of 9% and a median postoperative stay of 2 day. There were no instances of post-sphincterotomy pancreatitis or haemorrhage requiring transfusion.

Conclusion: An algorithm involving selective MRCP with endoscopic sphincterotomy is a safe, effective means of managing suspected choledocholithiasis, particularly where the expertise, equipment or theatre time for laparoscopic bile duct exploration is not routinely available MRCP may become a new additional alternative to ERCP and intraoperative cholangiography.

Scripta Scientifica Medica 2009; 41(2): 163-167.


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DOI: http://dx.doi.org/10.14748/ssm.v41i2.446

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About The Authors

Valentin Ignatov
Medical University of Varna
Bulgaria

Krasimir Ivanov
Medical University of Varna
Bulgaria

Nikola Kolev
Medical University of Varna
Bulgaria

Anton Tonev
Medical University of Varna
Bulgaria

M. Novakova
St. Marina University Hospital of Varna
Bulgaria

R. Georgiev
St. Marina University Hospital of Varna
Bulgaria

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