The southwestern surgical congress multi-center trial on suspected common duct stones - 24/05/19
, Justin Regner a, Michael S. Truitt b, Vaidehi Agrawal b, Megan Swope c, Clay Cothren Burlew c, Sharmila Dissanaike d, Divya Vangipurum d, Brandon Bruns e, Lindsay O'Meara e, John Stivers f, Amy Kwok f, Brandon T. Grover g, Shanu N. Kothari g, Chris Cibari h, Julie Dunn h, Robert C. McIntyre i, Frank Wright i, Elizabeth P. Scherer j, Christopher Crane j, Thomas J. Schroeppel k, Emma Callaghan k, Stephanie Gordy l, Rob Todd lAbstract |
Background |
Choledocholithiasis is present in up to 15% of cholecystectomy patients. Treatment can be surgical, endoscopic, or via interventional radiology. We hypothesized significant heterogeneity between hospitals exists in the approach to suspected common duct stones.
Methods |
A retrospective review of patients that had a preoperative MRCP, endoscopic ultrasound, endoscopic retrograde cholangiopancreatogram (ERCP), or intra-operative cholangiogram was performed. Comparisons were by Wilcoxon-Mann-Whitney tests with significance of p < 0.05 for paired variables and p < 0.017 for multiple comparisons.
Results |
Twelve participating institutions identified 1263 patients (409 men and 854 women) with a median age of 49 years (IQR: 31–94). Liver function tests (LFT's) were elevated in 939 patients (75%), median bilirubin level 1.75 mg/dl (IQ: 0.8–3.7 mg/dl) and median common duct size 7 mm (IQR 5–10 mm). The most common initial procedure was cholecystectomy with IOC at seven institutions, endoscopy at four and MRCP at one.
Conclusion |
Significant variation exists within the surgical community regarding suspected common duct stones. These results underscore the need for a protocol for common duct stones to minimize multiple, redundant interventions.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Retrospective multicenter review of 1263 patients with suspected common duct stones was performed. |
• | Approaches varied between institutions. |
• | A surgery first approach produced reduced length of stay compared to endoscopy or MRCP. |
• | Common duct exploration is performed infrequently. |
• | Opportunities exist for reduced hospitalization with a protocol based approach. |
Keywords : Choledocholithiasis, ERCP, MRCP, Common duct exploration
Plan
Vol 217 - N° 6
P. 1006-1009 - juin 2019 Retour au numéro
Article précédent
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