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Can ERCP contrast agents cause pseudomicrolithiasis? Their effect on the final outcome of bile analysis in patients
V K Parasher1, K Romain, R Sukumar
1Beebe Medical Center, Lewes, Delaware 19958, USA.
Background:
Microlithiasis has been implicated in the etiology of idiopathic pancreatitis and biliary-type pain in patients with intact gallbladders. Contrast injection at endoscopic retrograde cholangiopancreatography (ERCP) is used to confirm access into the bile duct and bile is also aspirated to look for microlithiasis. It is not known whether contrast agents contain crystals that could mimic true microlithiasis.
Methods:
Four mL of 2 contrast agents (Hypaque and Omnipaque) were examined after centrifugation under polarizing microscopy. In the second part of the study, bile aspirated during ERCP with contrast injection was examined for microlithiasis and contrast pseudomicrolithiasis.
Results:
Contrast agents exhibited pseudomicrolithiasis that mimicked calcium bilirubinate granules. Pathologists participating in the study were not aware of contrast pseudomicrolithiasis. Nine of twelve (75%) patients would have been reported as having microlithiasis and would possibly have undergone an unnecessary cholecystectomy.
Conclusion:
When bile collected during ERCP is to be examined for microlithiasis, it should be collected without contamination by a contrast agent. If this is not possible, pathologists should be aware that contrast can cause pseudomicrolithiasis.
Insights
Endoscopic retrograde cholangiopancreatography contrast agents can create false microlithiasis, mimicking true gallstones. Bile samples collected during ERCP should be free of contrast to avoid misdiagnosis of gallstone disease.
Area of Science:
- Gastroenterology
- Hepatology
- Diagnostic Imaging
Background:
- Microlithiasis is linked to idiopathic pancreatitis and biliary pain in patients with intact gallbladders.
- Endoscopic retrograde cholangiopancreatography (ERCP) uses contrast injection and bile aspiration to detect microlithiasis.
- The potential for contrast agents to cause pseudomicrolithiasis is unknown.
Purpose of the Study:
- To investigate whether contrast agents used in ERCP can form crystals that mimic true microlithiasis.
- To assess the impact of contrast-induced pseudomicrolithiasis on diagnostic accuracy.
Main Methods:
- Two contrast agents (Hypaque, Omnipaque) were examined under polarizing microscopy after centrifugation.
- Bile samples from ERCP procedures with contrast injection were analyzed for microlithiasis and contrast pseudomicrolithiasis.
Main Results:
- Contrast agents demonstrated pseudomicrolithiasis, resembling calcium bilirubinate granules.
- Pathologists were unaware of contrast pseudomicrolithiasis.
- 75% of patients (9/12) could have been misdiagnosed with microlithiasis, potentially leading to unnecessary cholecystectomy.
Conclusions:
- Bile for microlithiasis examination during ERCP must be collected without contrast contamination.
- Pathologists must be aware of contrast-induced pseudomicrolithiasis to ensure accurate diagnosis.