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. 2024 Mar 8;9(1):37-45.
doi: 10.1515/iss-2023-0059. eCollection 2024 Mar.

Is there a role for routine intraoperative cholangiogram in diagnosing CBD stones in patients with normal liver function tests? A prospective study

Yi Ping Lim  1 , Voon Meng Leow  2   3 , Jun Kit Koong  1 , Manisekar Subramaniam  3
Affiliations

Is there a role for routine intraoperative cholangiogram in diagnosing CBD stones in patients with normal liver function tests? A prospective study

Yi Ping Lim et al. Innov Surg Sci. .

Abstract

Objectives: Cholecystectomy with or without intraoperative cholangiogram (IOC) is an accepted treatment for cholelithiasis. Up to 11.6 % of cholecystectomies have incidental common bile duct (CBD) stones on IOC and 25.3 % of undiagnosed CBD stones will develop life-threatening complications. These will require additional intervention after primary cholecystectomy, further straining the healthcare system. We seek to examine the role of IOC in patients with normal LFTs by evaluating its predictive values, intending to treat undiagnosed CBD stones and therefore ameliorate these issues.

Methods: All patients who underwent cholecystectomies with normal LFTs from October 2019 to December 2020 were prospectively enrolled. IOC was done, ERCPs were performed for filling defects and documented as "true positive" if ERCP was congruent with the IOC. "False positives" were recorded if ERCP was negative. "True negative" was assigned to normal IOC and LFT after 2 weeks of follow-up. Those with abnormal LFTs were subjected to ERCP and documented as "false negative". Sensitivity, specificity, and predictive values were calculated.

Results: A total of 180 patients were analysed. IOC showed a specificity of 85.5 % and a NPV of 88.1 % with an AUC of 73.7 %. The positive predictive value and sensitivity were 56.5 and 61.9 % respectively.

Conclusions: Routine IOC is a specific diagnostic tool with good negative predictive value. It is useful to exclude the presence of CBD stones when LFT is normal. It does not significantly prolong the length of hospitalization or duration of the cholecystectomy hence reducing the incidence of undetected retained stones and preventing its complications effectively.

Keywords: cholangiography; cholecystectomy; choledocholithiasis; common bile duct gallstones; liver function tests.

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Conflict of interest statement

Competing interests: The authors state no conflict of interests.

Figures

Figure 1:
Figure 1:
Strobe flow diagram. ALP, Alkaline phosphatase; GGT, Gamma-glutamyltransferase.
Figure 2:
Figure 2:
ROC curve and area under ROC curve of IOC predicting CBD stones amongst patients with normal liver function tests (n=180).
See this image and copyright information in PMC

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