Protocol-Driven Management of Suspected Common Duct Stones

Area of Science:

• Gastroenterology
• Hepatobiliary Surgery

Background:

• Common duct stones are diagnosed using MRCP, EUS/ERCP, and IOC.
• A 2015 protocol stratified management based on bilirubin levels: preoperative EUS/ERCP for bilirubin >4.0 mg/dL, and IOC with potential postoperative EUS/ERCP for bilirubin <4.0 mg/dL.
• Exclusions included suspected malignancy and altered anatomy.

Purpose of the Study:

• To compare outcomes of a protocol-driven approach versus a pre-protocol (baseline) approach for managing common duct stones.
• To evaluate the impact on patient demographics, comorbidities, pancreatitis, diagnostic procedures, length of hospitalization, and postoperative morbidity.

Main Methods:

• Retrospective comparison of 56 protocol patients and 56 baseline patients.
• Analysis included patient demographics, risk factors, comorbidities, length of stay, and postoperative morbidity.
• Statistical analysis used t-test, chi-square, and Wilcoxon rank-sum test (p < 0.05 significance).

Main Results:

• No significant differences in demographics, comorbidities, pancreatitis, liver function tests, bilirubin, or common duct size between groups.
• Protocol patients had fewer endoscopies (22 vs. 35; p=0.014) and a shorter length of stay (2.8 vs. 3.8 days; p=0.025).
• Postoperative morbidity was not significantly different between the groups.

Conclusions:

• Protocol-driven management of common duct stones effectively reduced the number of endoscopies and length of hospitalization.
• This approach has the potential to decrease endoscopy-related morbidity and overall healthcare costs.
• The protocol maintained the quality of care without increasing postoperative morbidity.