Brief Article
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World J Gastroenterol. Sep 21, 2013; 19(35): 5877-5882
Published online Sep 21, 2013. doi: 10.3748/wjg.v19.i35.5877
Non-invasive assessment of choledocholithiasis in patients with gallstones and abnormal liver function
Bilal O Al-Jiffry, Abdeen Elfateh, Tariq Chundrigar, Bassem Othman, Owaid AlMalki, Fares Rayza, Hashem Niyaz, Hesham Elmakhzangy, Mohammed Hatem
Bilal O Al-Jiffry, Owaid AlMalki, Fares Rayza, Mohammed Hatem, Department of Surgery, College of Medicine and Medical Sciences, Taif University, Taif 21947, Saudi Arabia
Bilal O Al-Jiffry, Abdeen Elfateh, Tariq Chundrigar, Bassem Othman, Department of Surgery, Al-Hada Military Hospital, Taif 21947, Saudi Arabia
Hashem Niyaz, Hesham Elmakhzangy, Department of Gastroenterology, Al-Hada Military Hospital, Taif 21947, Saudi Arabia
Hesham Elmakhzangy, Department of Tropical Medicine, Faculty of Medicine, Cairo University, Cairo 11956, Egypt
Author contributions: Al-Jiffry BO designed the study and supervised the collection of all the data for 4 years; Elfateh A co-designed the study and co-supervised the collection of data; Chundrigar T contributed patient data and helped to draft the manuscript; Othman B, AlMalki O and Rayza F carried out data collection for one year; Niyaz H performed ERCP on the patients in this study and analyzed data; Elmakhzangy H performed ERCP on the patients along with Niyaz H and helped in analyzing the data; Hatem M contributed patient data and helped to draft the manuscript.
Correspondence to: Bilal O Al-Jiffry, MD, Department of Surgery, College of Medicine and Medical Sciences, Taif University, PO Box 888, Taif 21947, Saudi Arabia. jiffrybilal@hotmail.com
Telephone: +966-50-5924635 Fax: +966-27-541234
Received: January 11, 2013
Revised: May 24, 2013
Accepted: June 5, 2013
Published online: September 21, 2013
Processing time: 252 Days and 18 Hours
Abstract

AIM: To find a non-invasive strategy for detecting choledocholithiasis before cholecystectomy, with an acceptable negative rate of endoscopic retrograde cholangiopancreatography.

METHODS: All patients with symptomatic gallstones were included in the study. Patients with abnormal liver functions and common bile duct abnormalities on ultrasound were referred for endoscopic retrograde cholangiopancreatography. Patients with normal ultrasound were referred to magnetic resonance cholangiopancreatography. All those who had a negative magnetic resonance or endoscopic retrograde cholangiopancreatography underwent laparoscopic cholecystectomy with intraoperative cholangiography.

RESULTS: Seventy-eight point five percent of patients had laparoscopic cholecystectomy directly with no further investigations. Twenty-one point five percent had abnormal liver function tests, of which 52.8% had normal ultrasound results. This strategy avoided unnecessary magnetic resonance cholangiopancreatography in 47.2% of patients with abnormal liver function tests with a negative endoscopic retrograde cholangiopancreatography rate of 10%. It also avoided un-necessary endoscopic retrograde cholangiopancreatography in 35.2% of patients with abnormal liver function.

CONCLUSION: This strategy reduces the cost of the routine use of magnetic resonance cholangiopancreatography, in the diagnosis and treatment of common bile duct stones before laparoscopic cholecystectomy.

Keywords: Magnetic resonance cholangiopancreatography; Endoscopic retrograde cholangiopancreatography; Choledocholithiasis; Liver function tests; Laparoscopic cholecystectomy; Obstructive jaundice

Core tip: This strategy reduces the cost of the routine use of magnetic resonance cholangiopancreatography, in the diagnosis and treatment of common bile duct stones before laparoscopic cholecystectomy.