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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