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Reliability of ultrasounds in detecting common bile duct stones before biliary surgery. A retrospective analysis
S Contini1, R Dalla Valle, G Campanella
1General Surgical and Organ Transplantation Clinic, University of Parma, Italy.
Unlabelled:
The aim of this study is to evaluate the diagnostic benefit of US in the preoperative screening for CBD stones in patients submitted to surgery for biliary lithiasis.
Materials And Methods:
We analyzed the data of 135 patients admitted for biliary lithiasis, jaundice or biliary pancreatitis in the last three years. Mean age was 63 years (54.8% females), 48% of the cases had an urgent admission. US of the liver and biliary ducts was the first examination performed and the patients were divided in 2 groups on the bases of the results: those with the diameter of the CBD < 1 cm (101 pts-group A) and those with a diameter > 1 cm (34 pts-group B).
Results:
In group A were subsequently performed: 35 IV cholangiographies (6 showed CBD stones, 1 was a false negative for CBD stones), 15 intraoperative (I.O.) cholangiographies (1 positive for CBD stones), 9 ERCP for jaundice or pancreatitis (2 positive for CBD stones). The incidence of CBD stones was 8.9% in this group. In group B were performed: 7 IV cholangiographies (2 showed CBD stones), 12 I.O. cholangiographies (6 showed CBD stones), 10 ERCP for jaundice or pancreatitis (7 showed CBD stones). The incidence of CBD stones was 44% in this group. CBD stones were detected by US in 2 cases (22%) in group A and in 6 cases (40%) in group B.
Conclusions:
In our patients there is a relatively high incidence of CBD stones (8.9%) in spite of a normal CBD at US. Considering that the minimally invasive approach for the gallbladder stones is becoming the "gold standard" and the laparoscopic treatment of the CBD stones is not widely diffused, it is important to know the presence of CBD stones before surgery. With this in mind US does not seem to be a reliable diagnostic tool and we suggest that before surgery an IV cholangiography (sensitivity > 95% in our experience) should be performed together with US and ERCP in selected cases. Moreover this could reduce the number of preoperative ERCP leaving the possibility to treat more selectively by endoscopic papillosphincterotomy the patients with CBD stones before laparoscopic cholecystectomy.