Luthra Anjuli K, Aggarwal Vipul, Mishra Girish, Conway Jason, Evans John A
Department of Gastroenterology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA.
Am Surg. 2016 Apr;82(4):343-7.
During laparoscopic cholecystectomy, intraoperative cholangiography (IOC) is used to identify common bile duct (CBD) stones. In patients whose IOC is suspicious for stones, endoscopic retrograde cholangiopancreatography (ERCP) is the modality of choice for stone removal. However, IOC has a false positive rate of 30 to 60 per cent, and ERCP adverse events may occur in 11 per cent of patients. Endoscopic ultrasound (EUS) may serve as a noninvasive means of diagnosing suspected CBD stones. This study sought to assess the role of EUS in predicting the likelihood of choledocholithiasis at ERCP in patients found to have a positive IOC. This was a prospective blinded study of EUS before ERCP in patients with a positive IOC. Recruited subjects who underwent cholecystectomy and had an IOC with suspicion for obstruction were referred for ERCP within one month of their procedure. In patients with a positive IOC, EUS had a positive predictive value of 95 per cent in detecting choledocholithiasis. IOC with single or multiple filling defects more often correlated to the presence of CBD stones. At ERCP, choledocholithiasis was present in 65 per cent of patients who had an IOC suspicious for CBD stones. EUS should be used as a noninvasive method to correctly identify retained CBD stones in low-to-moderate risk patients with a positive IOC.
在腹腔镜胆囊切除术中，术中胆管造影（IOC）用于识别胆总管（CBD）结石。对于IOC怀疑有结石的患者，内镜逆行胰胆管造影（ERCP）是取石的首选方法。然而，IOC的假阳性率为30%至60%，且11%的患者可能发生ERCP不良事件。内镜超声（EUS）可作为诊断可疑CBD结石的一种非侵入性手段。本研究旨在评估EUS在预测IOC阳性患者ERCP时胆总管结石可能性方面的作用。这是一项对IOC阳性患者在ERCP前进行EUS检查的前瞻性盲法研究。接受胆囊切除术且IOC怀疑有梗阻的入选受试者在手术一个月内接受ERCP检查。在IOC阳性的患者中，EUS检测胆总管结石的阳性预测值为95%。有单个或多个充盈缺损的IOC更常与CBD结石的存在相关。在ERCP时，IOC怀疑有CBD结石的患者中有65%存在胆总管结石。EUS应用作一种非侵入性方法，以正确识别IOC阳性的低至中度风险患者中残留的CBD结石。
