Upper Gastrointestinal and Hepatobiliary Surgery Unit, Department of General Surgery, Monash Health, 246 Clayton Road, Clayton, VIC 3168, Australia.
Upper Gastrointestinal and Hepatobiliary Surgery Unit, Department of General Surgery, Monash Health, 246 Clayton Road, Clayton, VIC 3168, Australia.
HPB (Oxford). 2021 Apr;23(4):538-544. doi: 10.1016/j.hpb.2020.08.010. Epub 2020 Sep 28.
Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure performed to remove bile duct stones. Intraoperative cholangiography (IOC) is often performed at the time of cholecystectomy to determine the presence of intraductal stones. However, many of the ERCP procedures performed for this indication fail to find any intraductal stones. Given that ERCP carries significant patient morbidity, we investigated whether there are features on IOC that can guide ERCP patient selection.
A retrospective analysis of 152 patients who had an IOC filing defect and a subsequent ERCP was performed.
Small single stones greater than or equal to 4.5 mm on IOC can be used to predict the presence of stones on a subsequent ERCP. Furthermore, ERCPs performed for single filling defects smaller than 4.5 mm are more likely to be negative if performed later rather than earlier, suggesting that small stones can pass over time. We show that 80% of these stones will pass by 11 days after the IOC.
Single small stones on IOC should be given adequate time to pass into the intestine. Imaging should be performed to determine if the stone has passed into the intestine after day 11 prior to performing a therapeutic ERCP.
内镜逆行胰胆管造影术（ERCP）是一种用于取出胆管结石的程序。在胆囊切除术中，通常会进行术中胆管造影术（IOC）以确定是否存在胆管内结石。然而，许多针对该指征进行的 ERCP 手术未能发现任何胆管内结石。鉴于 ERCP 会给患者带来很大的发病率，我们研究了 IOC 上是否存在可以指导 ERCP 患者选择的特征。
对 152 名进行 IOC 充盈缺损检查且随后进行 ERCP 的患者进行回顾性分析。
IOC 上的单个大于或等于 4.5 毫米的小结石可用于预测后续 ERCP 中结石的存在。此外，如果在较小的情况下进行 ERCP，那么对于小于 4.5 毫米的单个充盈缺损进行 ERCP 更有可能为阴性，这表明小结石可以随着时间的推移而通过。我们发现，这些结石中有 80%会在 IOC 后 11 天内通过。
IOC 上的单个小结石应给予足够的时间排入肠道。在进行治疗性 ERCP 之前，应进行影像学检查以确定结石是否在第 11 天已排入肠道。
