Department of Gastroenterology and Hepatology, Radboudumc, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
Department of Research and Development, St. Antonius ziekenhuis, Nieuwegein, The Netherlands.
Surg Endosc. 2023 Feb;37(2):1194-1202. doi: 10.1007/s00464-022-09615-x. Epub 2022 Sep 26.
Endoscopic retrograde cholangiopancreatography (ERCP) is the procedure of choice to remove sludge/stones from the common bile duct (CBD). In a small but clinically important proportion of patients with suspected choledocholithiasis ERCP is negative. This is undesirable because of ERCP associated morbidity. We aimed to map the diagnostic pathway leading up to ERCP and evaluate ERCP outcome.
We established a prospective multicenter cohort of patients with suspected CBD stones. We assessed the determinants that were associated with CBD sludge or stone detection upon ERCP.
We established a cohort of 707 patients with suspected CBD sludge or stones (62% female, median age 59 years). ERCP was negative for CBD sludge or stones in 155 patients (22%). Patients with positive ERCPs frequently had pre-procedural endoscopic ultrasonography (EUS) or magnetic resonance cholangiopancreatography (MRCP) imaging (44% vs. 35%; P = 0.045). The likelihood of ERCP sludge and stones detection was higher when the time interval between EUS or MRCP and ERCP was less than 2 days (odds ratio 2.35; 95% CI 1.25-4.44; P = 0.008; number needed to harm 7.7).
Even in the current era of society guidelines and use of advanced imaging CBD sludge or stones are absent in one out of five ERCPs performed for suspected CBD stones. The proportion of unnecessary ERCPs is lower in case of pre-procedural EUS or MRCP. A shorter time interval between EUS or MRCP increases the yield of ERCP for suspected CBD stones and should, therefore, preferably be performed within 2 days before ERCP.
内镜逆行胰胆管造影术（ERCP）是从胆总管（CBD）中取出泥沙/结石的首选方法。在一小部分但临床上很重要的疑似胆总管结石患者中，ERCP 为阴性。这是不理想的，因为 ERCP 相关发病率。我们旨在绘制导致 ERCP 的诊断途径，并评估 ERCP 的结果。
我们建立了一个前瞻性多中心疑似 CBD 结石患者队列。我们评估了与 ERCP 时 CBD 泥沙或结石检测相关的决定因素。
我们建立了一个有 707 名疑似 CBD 泥沙或结石患者的队列（62%为女性，中位年龄 59 岁）。155 名患者（22%）的 ERCP 对 CBD 泥沙或结石呈阴性。经常进行 ERCP 前内镜超声检查（EUS）或磁共振胰胆管造影（MRCP）成像的患者（44%比 35%；P=0.045）。EUS 或 MRCP 与 ERCP 之间的时间间隔小于 2 天时，ERCP 检测泥沙和结石的可能性更高（优势比 2.35；95%CI 1.25-4.44；P=0.008；危害比 7.7）。
即使在当前社会指南的时代，在为疑似 CBD 结石进行的 5 次 ERCP 中，仍有 1 次没有 CBD 泥沙或结石。在进行 ERCP 前进行 EUS 或 MRCP 的情况下，不必要的 ERCP 比例较低。EUS 或 MRCP 之间的时间间隔越短，ERCP 对疑似 CBD 结石的检出率越高，因此，最好在 ERCP 前 2 天内进行。
