Vadlamudi Raja, Conway Jason, Mishra Girish, Baillie John, Gilliam John, Fernandez Adolfo, Evans John
Dr Vadlamudi is a gastroenterology fellow in the Department of Medicine at SUNY Upstate Medical University in Syracuse, New York. Drs Conway, Mishra, Gilliam, Fernandez, and Evans are affiliated with the Wake Forest School of Medicine in Winston-Salem, North Carolina. Dr Conway is an assistant professor of internal medicine, director of Endoscopic Ultrasound Services and the Advanced Endoscopy Fellowship Program in the Department of Internal Medicine; Dr Mishra is an associate professor of medicine, director of Endoscopy & Clinical Services, and vice chief of the Division of Gastroenterology; Drs Gilliam and Evans are assistant professors of medicine in the Division of Gastroenterology; and Dr Fernandez is an associate professor of surgery in the Department of General Surgery. Dr Baillie is the director of medical gastro-enterology at the Carteret Medical Group in Morehead City, North Carolina.
Gastroenterol Hepatol (N Y). 2014 Apr;10(4):240-4.
The false-positive rates of a positive intraoperative cholangiogram (IOC) are as high as 60%. Endoscopic retrograde cholangiopancreatography (ERCP) for stone removal is required after a positive IOC. It is unclear which clinical factors identify patients most likely to have a stone after a positive IOC. This study was conducted to identify factors predictive of common bile duct (CBD) stone(s) on ERCP after a positive IOC. A retrospective review of our endoscopic database identified all ERCP and/or endoscopic ultrasound (EUS) procedures performed for a positive IOC between August 2003 and August 2009. Collected data included patient demographics; indication for cholecystectomy; IOC findings; blood tests before and after cholecystectomy, including liver function tests, complete blood count, and amylase and lipase measurements; and ERCP and/or EUS results. Patients who had a negative EUS for CBD stones and no subsequent ERCP were contacted by phone to see if they eventually required an ERCP. Univariate and multi-variable analyses were performed. A total of 114 patients were included in the study. IOC findings included a single stone, multiple stones, nonpassage of contrast into the duodenum, dilated CBD, and poor visualization of the bile duct. Eighty-four percent of patients had ERCP only, 9% had EUS only, and 7% had EUS followed by ERCP. Sixty-five patients (57%) had CBD stones on ERCP or EUS. Older age, multiple stones, dilated CBD on IOC, and elevated postcholecystectomy bilirubin levels were the clinical variables with statistically significant differences on univariate analysis. On multivariable analysis, older age and elevated postcholecystectomy total bilirubin levels correlated with the presence of CBD stones on ERCP. Fifty-seven percent of patients referred for endoscopic evaluation after a positive IOC had CBD stones on ERCP. Patients with CBD stones after a positive IOC were more likely to be older with elevated post-cholecystectomy total serum bilirubin levels.
术中胆管造影（IOC）阳性的假阳性率高达60%。IOC阳性后需要进行内镜逆行胰胆管造影（ERCP）取石。目前尚不清楚哪些临床因素可识别出IOC阳性后最有可能存在结石的患者。本研究旨在确定IOC阳性后ERCP检查中预测胆总管（CBD）结石的因素。对我们的内镜数据库进行回顾性分析，确定了2003年8月至2009年8月期间因IOC阳性而进行的所有ERCP和/或内镜超声（EUS）检查。收集的数据包括患者人口统计学资料；胆囊切除术指征；IOC检查结果；胆囊切除术前和术后的血液检查，包括肝功能检查、全血细胞计数以及淀粉酶和脂肪酶测定；以及ERCP和/或EUS检查结果。对CBD结石EUS检查阴性且未进行后续ERCP的患者进行电话随访，以了解他们最终是否需要进行ERCP。进行了单因素和多因素分析。共有114例患者纳入本研究。IOC检查结果包括单发结石、多发结石、造影剂未进入十二指肠、CBD扩张以及胆管显影不佳。84%的患者仅接受了ERCP检查，9%的患者仅接受了EUS检查，7%的患者先接受了EUS检查，随后进行了ERCP检查。65例（57%）患者在ERCP或EUS检查中发现有CBD结石。年龄较大、多发结石、IOC检查显示CBD扩张以及胆囊切除术后胆红素水平升高是单因素分析中有统计学显著差异的临床变量。多因素分析显示，年龄较大和胆囊切除术后总胆红素水平升高与ERCP检查中CBD结石的存在相关。IOC阳性后接受内镜评估的患者中，57%在ERCP检查中发现有CBD结石。IOC阳性后有CBD结石的患者更有可能年龄较大，且胆囊切除术后总血清胆红素水平升高。
