Can clinical factors predict the need for intervention after a positive intraoperative cholangiogram?

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Abstract

OBJECTIVE: To determine whether clinical factors such as the elevation or decline of biochemical liver tests and bile duct dilation can help to identify patients who will truly benefit from therapeutic endoscopic retrograde cholangiopancreatography (ERCP) following a positive intraoperative cholangiography (IOC) study. METHODS: All cholecystectomies during a 3-year period were examined retrospectively for positive intraoperative cholangiograms. Sonographic findings of bile duct dilation and transaminase levels at admission, including trends during the course of hospitalization and prior to ERCP, were evaluated. RESULTS: Of 369 patients with intraoperative cholangiogram studies, 80 (21.7%) were positive. Prior to surgery, a sonogram showed biliary dilation in 50 (62.5%) and ERCP demonstrated actual stones in 27 (61.4%) out of 44 patients. In 24 patients with persistent elevation in transaminases and no biliary dilation, ERCP revealed stones in 12 (50.0%). Sonographic finding of biliary dilation had a positive predictive value (PPV) of 61.4% and a negative predictive value (NPV) of 60.0%. Persistent elevation in transaminases had a PPV of 59.3%. A 50% decline in transaminases had a NPV of 41.2%. Overall, only 39 (48.8%) of all patients with a positive intraoperative cholangiogram study required therapeutic ERCP. CONCLUSIONS: Elevated transaminases and sonographic biliary dilation have poor predictive values for choledocholithiasis. Thus, patients with a positive intraoperative cholangiogram may benefit from additional studies, such as endoscopic ultrasound or magnetic resonance cholangiopancreatography prior to ERCP.

Original languageEnglish (US)
Pages (from-to)410-415
Number of pages6
JournalJournal of Digestive Diseases
Volume18
Issue number7
DOIs
StatePublished - Jul 1 2017

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Endoscopic Retrograde Cholangiopancreatography
Dilatation
Transaminases
Bile Ducts
Magnetic Resonance Cholangiopancreatography
Choledocholithiasis
Cholangiography
Cholecystectomy
Hospitalization
Liver
Therapeutics

Keywords

  • cholecystectomy
  • choledocholithiasis
  • endoscopic retrograde cholangiopancreatography
  • intraoperative cholangiogram

ASJC Scopus subject areas

  • Gastroenterology

Cite this

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title = "Can clinical factors predict the need for intervention after a positive intraoperative cholangiogram?",
abstract = "OBJECTIVE: To determine whether clinical factors such as the elevation or decline of biochemical liver tests and bile duct dilation can help to identify patients who will truly benefit from therapeutic endoscopic retrograde cholangiopancreatography (ERCP) following a positive intraoperative cholangiography (IOC) study. METHODS: All cholecystectomies during a 3-year period were examined retrospectively for positive intraoperative cholangiograms. Sonographic findings of bile duct dilation and transaminase levels at admission, including trends during the course of hospitalization and prior to ERCP, were evaluated. RESULTS: Of 369 patients with intraoperative cholangiogram studies, 80 (21.7{\%}) were positive. Prior to surgery, a sonogram showed biliary dilation in 50 (62.5{\%}) and ERCP demonstrated actual stones in 27 (61.4{\%}) out of 44 patients. In 24 patients with persistent elevation in transaminases and no biliary dilation, ERCP revealed stones in 12 (50.0{\%}). Sonographic finding of biliary dilation had a positive predictive value (PPV) of 61.4{\%} and a negative predictive value (NPV) of 60.0{\%}. Persistent elevation in transaminases had a PPV of 59.3{\%}. A 50{\%} decline in transaminases had a NPV of 41.2{\%}. Overall, only 39 (48.8{\%}) of all patients with a positive intraoperative cholangiogram study required therapeutic ERCP. CONCLUSIONS: Elevated transaminases and sonographic biliary dilation have poor predictive values for choledocholithiasis. Thus, patients with a positive intraoperative cholangiogram may benefit from additional studies, such as endoscopic ultrasound or magnetic resonance cholangiopancreatography prior to ERCP.",
keywords = "cholecystectomy, choledocholithiasis, endoscopic retrograde cholangiopancreatography, intraoperative cholangiogram",
author = "Mohammed Kaif and Deepak Agrawal and Jayaprakash Sreenarasimhaiah",
year = "2017",
month = "7",
day = "1",
doi = "10.1111/1751-2980.12488",
language = "English (US)",
volume = "18",
pages = "410--415",
journal = "Journal of Digestive Diseases",
issn = "1751-2972",
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number = "7",

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T1 - Can clinical factors predict the need for intervention after a positive intraoperative cholangiogram?

AU - Kaif, Mohammed

AU - Agrawal, Deepak

AU - Sreenarasimhaiah, Jayaprakash

PY - 2017/7/1

Y1 - 2017/7/1

N2 - OBJECTIVE: To determine whether clinical factors such as the elevation or decline of biochemical liver tests and bile duct dilation can help to identify patients who will truly benefit from therapeutic endoscopic retrograde cholangiopancreatography (ERCP) following a positive intraoperative cholangiography (IOC) study. METHODS: All cholecystectomies during a 3-year period were examined retrospectively for positive intraoperative cholangiograms. Sonographic findings of bile duct dilation and transaminase levels at admission, including trends during the course of hospitalization and prior to ERCP, were evaluated. RESULTS: Of 369 patients with intraoperative cholangiogram studies, 80 (21.7%) were positive. Prior to surgery, a sonogram showed biliary dilation in 50 (62.5%) and ERCP demonstrated actual stones in 27 (61.4%) out of 44 patients. In 24 patients with persistent elevation in transaminases and no biliary dilation, ERCP revealed stones in 12 (50.0%). Sonographic finding of biliary dilation had a positive predictive value (PPV) of 61.4% and a negative predictive value (NPV) of 60.0%. Persistent elevation in transaminases had a PPV of 59.3%. A 50% decline in transaminases had a NPV of 41.2%. Overall, only 39 (48.8%) of all patients with a positive intraoperative cholangiogram study required therapeutic ERCP. CONCLUSIONS: Elevated transaminases and sonographic biliary dilation have poor predictive values for choledocholithiasis. Thus, patients with a positive intraoperative cholangiogram may benefit from additional studies, such as endoscopic ultrasound or magnetic resonance cholangiopancreatography prior to ERCP.

AB - OBJECTIVE: To determine whether clinical factors such as the elevation or decline of biochemical liver tests and bile duct dilation can help to identify patients who will truly benefit from therapeutic endoscopic retrograde cholangiopancreatography (ERCP) following a positive intraoperative cholangiography (IOC) study. METHODS: All cholecystectomies during a 3-year period were examined retrospectively for positive intraoperative cholangiograms. Sonographic findings of bile duct dilation and transaminase levels at admission, including trends during the course of hospitalization and prior to ERCP, were evaluated. RESULTS: Of 369 patients with intraoperative cholangiogram studies, 80 (21.7%) were positive. Prior to surgery, a sonogram showed biliary dilation in 50 (62.5%) and ERCP demonstrated actual stones in 27 (61.4%) out of 44 patients. In 24 patients with persistent elevation in transaminases and no biliary dilation, ERCP revealed stones in 12 (50.0%). Sonographic finding of biliary dilation had a positive predictive value (PPV) of 61.4% and a negative predictive value (NPV) of 60.0%. Persistent elevation in transaminases had a PPV of 59.3%. A 50% decline in transaminases had a NPV of 41.2%. Overall, only 39 (48.8%) of all patients with a positive intraoperative cholangiogram study required therapeutic ERCP. CONCLUSIONS: Elevated transaminases and sonographic biliary dilation have poor predictive values for choledocholithiasis. Thus, patients with a positive intraoperative cholangiogram may benefit from additional studies, such as endoscopic ultrasound or magnetic resonance cholangiopancreatography prior to ERCP.

KW - cholecystectomy

KW - choledocholithiasis

KW - endoscopic retrograde cholangiopancreatography

KW - intraoperative cholangiogram

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