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John G. Hunter - One of the best experts on this subject based on the ideXlab platform.

  • Future Treatment of Common Bile Duct Stones.
    Seminars in laparoscopic surgery, 1997
    Co-Authors: Alfred B. Johnson, John G. Hunter
    Abstract:

    Management options for patients found to have Common Bile Duct stones have expanded as a function of improved instrumentation and radiographic support. Technological advances initially lead to increased costs but eventually result in improved quality for patients. Controversy exists for patients with either soft clinical findings or stones found at the time of laparoscopic cholecystectomy. As laparoscopic Common Duct exploration becomes more widespread the need for perioperative ERCP will likely decrease; however, this will depend on the experience of the surgeons at a given institution. Common Bile Duct stones found at the time of laparoscopic cholecystectomy can be approached in a variety of different ways. The most Commonly used methods are laparoscopic transcystic Common Bile Duct exploration, laparoscopic choledochotomy with Common Bile Duct exploration, open Common Bile Duct exploration, laparoscopic antegrade sphincterotomy, and postoperative ERCP. In the future, the treatment goal of biliary lithiasis will be to accomplish cholecystectomy and removal of Bile Duct stones in a single stage. Advances in fiberoptic technology will make transcystic Duct exploration more effective, but it is likely that sphincterotomy (antegrade or retrograde) will be used preferentially for the distally impacted stone.

  • laparoscopic transcystic Common Bile Duct exploration
    American Journal of Surgery, 1992
    Co-Authors: John G. Hunter
    Abstract:

    This study reviews the results of transcystic Common Bile Duct exploration (CBDE) for unsuspected stones found during laparoscopic cholecystectomy by a single surgeon in 150 consecutive patients. Fluoroscopic cholangiography was attempted in all but four patients. If the cholangiogram appeared to show Common Bile Duct (CBD) stones, a 5 Fr, 8-mm ureteral stone basket was passed through the cystic Duct into the duodenum, opened, and trolled through the CBD. Routine cholangiography was successful in 131 of 144 attempts (90%). An indication for CBDE was found by cholangiogram in seven patients (5%). Two cholangiograms were falsely positive. Stones were removed in five patients. Completion cholangiograms were normal in all patients. One patient developed mild pancreatitis but was discharged 2 days after laparoscopic cholecystectomy. The remainder were discharged on postoperative day 1. One patient was readmitted on postoperative day 2, possibly having passed a retained stone. Fluoroscopic CBDE was successful in clearing the CBD in all patients in this small series and deserves further evaluation.

G. Szinicz - One of the best experts on this subject based on the ideXlab platform.

  • Laparoscopic management of Common Bile Duct stones
    Surgical Endoscopy And Other Interventional Techniques, 2004
    Co-Authors: S. Ebner, J. Rechner, S. Beller, K. Erhart, F. M. Riegler, G. Szinicz
    Abstract:

    Background While laparoscopic cholecystectomy is widely accepted for therapy of cholecystolithiasis, controversy still exists concerning the management of Common Bile Duct stones. Besides preoperative endoscopic papillotomy followed by laparoscopic cholecystectomy and open Common Bile Duct surgery, management of Common Bile Duct stones can be conDucted by laparoscopy, if respective experience is available. Method During laparoscopic cholecystectomy a cholangiography via the cystic Duct is routinely performed. If Bile Duct stones are detected they are retrieved via the cystic Duct or via incision of the Common Bile Duct by insertion of a Fogarty catheter or Dormia basket. Exclusion criteria against simultaneous laparoscopic management include suspicion of malignancy, severe pancreatitis, or cholangitis. Results From November 1991 to March 2002, 200 patients primarily underwent laparoscopic therapy of Bile Duct stones. Retrieval was performed via cystic Duct and Common Bile Duct incision in 115 and 85 cases, respectively. Complete removal was achieved in 91%; complication rate and mortality was 7% and 0.5%, respectively. During the same period primary endoscopic papillotomy was necessary in 40 patients because of the above contraindications. Conclusions When correct indications and surgical expertise are observed, simultaneous laparoscopic management of Common Bile Duct stones represents a safe and minimally invasive alternative to a two-procedure approach.

  • Laparoscopic management of Common Bile Duct stones
    Surgical endoscopy, 2004
    Co-Authors: S. Ebner, J. Rechner, S. Beller, K. Erhart, F. M. Riegler, G. Szinicz
    Abstract:

    Background While laparoscopic cholecystectomy is widely accepted for therapy of cholecystolithiasis, controversy still exists concerning the management of Common Bile Duct stones. Besides preoperative endoscopic papillotomy followed by laparoscopic cholecystectomy and open Common Bile Duct surgery, management of Common Bile Duct stones can be conDucted by laparoscopy, if respective experience is available.

Brian R Davidson - One of the best experts on this subject based on the ideXlab platform.

  • endoscopic ultrasound versus magnetic resonance cholangiopancreatography for Common Bile Duct stones
    Cochrane Database of Systematic Reviews, 2015
    Co-Authors: Vanja Giljaca, Kurinchi Selvan Gurusamy, Yemisi Takwoingi, David Higgie, Goran Poropat, Davor Stimac, Brian R Davidson
    Abstract:

    Endoscopic ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP) are tests used in the diagnosis of Common Bile Duct stones in patients suspected of having Common Bile Duct stones prior to undergoing invasive treatment. There has been no systematic review of the accuracy of EUS and MRCP in the diagnosis of Common Bile Duct stones using appropriate reference standards. Objectives were to determine and compare the accuracy of EUS and MRCP for the diagnosis of Common Bile Duct stones. We searched MEDLINE, EMBASE, Science Citation Index Expanded, BIOSIS, and Clinicaltrials.gov until September 2012. We searched the references of included studies to identify further studies and of systematic reviews identified from various databases (Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment (HTA), Medion, and ARIF (Aggressive Research Intelligence Facility)). We did not restrict studies based on language or publication status, or whether data were collected prospectively or retrospectively. We included studies that provided the number of true positives, false positives, false negatives, and true negatives for EUS or MRCP. We only accepted studies that confirmed the presence of Common Bile Duct stones by extraction of the stones (irrespective of whether this was done by surgical or endoscopic methods) for a positive test, and absence of Common Bile Duct stones by surgical or endoscopic negative exploration of the Common Bile Duct or symptom free follow-up for at least six months for a negative test, as the reference standard in people suspected of having Common Bile Duct stones. We included participants with or without prior diagnosis of cholelithiasis ; with or without symptoms and complications of Common Bile Duct stones, with or without prior treatment for Common Bile Duct stones ; and before or after cholecystectomy. At least two authors independently screened abstracts and selected studies for inclusion. Two authors independently collected the data from each study. We used the bivariate model to obtain pooled estimates of sensitivity and specificity. We included a total of 18 studies involving 2366 participants (976 participants with Common Bile Duct stones and 1390 participants without Common Bile Duct stones). Eleven studies evaluated EUS alone, and five studies evaluated MRCP alone. Two studies evaluated both tests. Most studies included patients who were suspected of having Common Bile Duct stones based on abnormal liver function tests ; abnormal transabdominal ultrasound ; symptoms such as obstructive jaundice, cholangitis, or pancreatitis ; or a combination of the above. The proportion of participants who had undergone cholecystectomy varied across studies. Not one of the studies was of high methodological quality. For EUS, the sensitivities ranged between 0.75 and 1.00 and the specificities ranged between 0.85 and 1.00. The summary sensitivity (95% confidence interval (CI)) and specificity (95% CI) of the 13 studies that evaluated EUS (1537 participants ; 686 cases and 851 participants without Common Bile Duct stones) were 0.95 (95% CI 0.91 to 0.97) and 0.97 (95% CI 0.94 to 0.99). For MRCP, the sensitivities ranged between 0.77 and 1.00 and the specificities ranged between 0.73 and 0.99. The summary sensitivity and specificity of the seven studies that evaluated MRCP (996 participants ; 361 cases and 635 participants without Common Bile Duct stones) were 0.93 (95% CI 0.87 to 0.96) and 0.96 (95% CI 0.90 to 0.98). There was no evidence of a difference in sensitivity or specificity between EUS and MRCP (P value = 0.5). From the included studies, at the median pre-test probability of Common Bile Duct stones of 41% the post-test probabilities (with 95% CI) associated with positive and negative EUS test results were 0.96 (95% CI 0.92 to 0.98) and 0.03 (95% CI 0.02 to 0.06). At the same pre-test probability, the post-test probabilities associated with positive and negative MRCP test results were 0.94 (95% CI 0.87 to 0.97) and 0.05 (95% CI 0.03 to 0.09). Both EUS and MRCP have high diagnostic accuracy for detection of Common Bile Duct stones. People with positive EUS or MRCP should undergo endoscopic or surgical extraction of Common Bile Duct stones and those with negative EUS or MRCP do not need further invasive tests. However, if the symptoms persist, further investigations will be indicated. The two tests are similar in terms of diagnostic accuracy and the choice of which test to use will be informed by availability and contra-indications to each test. However, it should be noted that the results are based on studies of poor methodological quality and so the results should be interpreted with caution. Further studies that are of high methodological quality are necessary to determine the diagnostic accuracy of EUS and MRCP for the diagnosis of Common Bile Duct stones.

  • endoscopic retrograde cholangiopancreatography versus intraoperative cholangiography for diagnosis of Common Bile Duct stones
    Cochrane Database of Systematic Reviews, 2015
    Co-Authors: Kurinchi Selvan Gurusamy, Vanja Giljaca, Yemisi Takwoingi, David Higgie, Goran Poropat, Davor Stimac, Brian R Davidson
    Abstract:

    Background Endoscopic retrograde cholangiopancreatography (ERCP) and intraoperative cholangiography (IOC) are tests used in the diagnosis of Common Bile Duct stones in people suspected of having Common Bile Duct stones. There has been no systematic review of the diagnostic accuracy of ERCP and IOC. Objectives To determine and compare the accuracy of ERCP and IOC for the diagnosis of Common Bile Duct stones. Search methods We searched MEDLINE, EMBASE, Science Citation Index Expanded, BIOSIS, and Clinicaltrials.gov to September 2012. To identify additional studies, we searched the references of included studies and systematic reviews identified from various databases (Database of Abstracts of Reviews of Effects (DARE)), Health Technology Assessment (HTA), Medion, and ARIF (Aggressive Research Intelligence Facility)). We did not restrict studies based on language or publication status, or whether data were collected prospectively or retrospectively. Selection criteria We included studies that provided the number of true positives, false positives, false negatives, and true negatives for ERCP or IOC. We only accepted studies that confirmed the presence of Common Bile Duct stones by extraction of the stones (irrespective of whether this was done by surgical or endoscopic methods) for a positive test, and absence of Common Bile Duct stones by surgical or endoscopic negative exploration of the Common Bile Duct, or symptom-free follow-up for at least six months for a negative test as the reference standard in people suspected of having Common Bile Duct stones. We included participants with or without prior diagnosis of cholelithiasis; with or without symptoms and complications of Common Bile Duct stones; with or without prior treatment for Common Bile Duct stones; and before or after cholecystectomy. At least two authors screened abstracts and selected studies for inclusion independently. Data collection and analysis Two authors independently collected data from each study. We used the bivariate model to summarise the sensitivity and specificity of the tests. Main results We identified five studies including 318 participants (180 participants with and 138 participants without Common Bile Duct stones) that reported the diagnostic accuracy of ERCP and five studies including 654 participants (125 participants with and 529 participants without Common Bile Duct stones) that reported the diagnostic accuracy of IOC. Most studies included people with symptoms (participants with jaundice or pancreatitis) suspected of having Common Bile Duct stones based on blood tests, ultrasound, or both, prior to the performance of ERCP or IOC. Most studies included participants who had not previously undergone removal of the gallbladder (cholecystectomy). None of the included studies was of high methodological quality as evaluated by the QUADAS-2 tool (quality assessment tool for diagnostic accuracy studies). The sensitivities of ERCP ranged between 0.67 and 0.94 and the specificities ranged between 0.92 and 1.00. For ERCP, the summary sensitivity was 0.83 (95% confidence interval (CI) 0.72 to 0.90) and specificity was 0.99 (95% CI 0.94 to 1.00). The sensitivities of IOC ranged between 0.75 and 1.00 and the specificities ranged between 0.96 and 1.00. For IOC, the summary sensitivity was 0.99 (95% CI 0.83 to 1.00) and specificity was 0.99 (95% CI 0.95 to 1.00). For ERCP, at the median pre-test probability of Common Bile Duct stones of 0.35 estimated from the included studies (i.e., 35% of people suspected of having Common Bile Duct stones were confirmed to have gallstones by the reference standard), the post-test probabilities associated with positive test results was 0.97 (95% CI 0.88 to 0.99) and negative test results was 0.09 (95% CI 0.05 to 0.14). For IOC, at the median pre-test probability of Common Bile Duct stones of 0.35, the post-test probabilities associated with positive test results was 0.98 (95% CI 0.85 to 1.00) and negative test results was 0.01 (95% CI 0.00 to 0.10). There was weak evidence of a difference in sensitivity (P value = 0.05) with IOC showing higher sensitivity than ERCP. There was no evidence of a difference in specificity (P value = 0.7) with both tests having similar specificity. Authors' conclusions Although the sensitivity of IOC appeared to be better than that of ERCP, this finding may be unreliable because none of the studies compared both tests in the same study populations and most of the studies were methodologically flawed. It appears that both tests were fairly accurate in guiding further invasive treatment as most people diagnosed with Common Bile Duct stones by these tests had Common Bile Duct stones. Some people may have Common Bile Duct stones in spite of having a negative ERCP or IOC result. Such people may have to be re-tested if the clinical suspicion of Common Bile Duct stones is very high because of their symptoms or persistently abnormal liver function tests. However, the results should be interpreted with caution given the limited quantity and quality of the evidence.

T.j.m.v. Vroonhoven - One of the best experts on this subject based on the ideXlab platform.

  • Management of Common Bile Duct stones
    Surgical endoscopy, 2002
    Co-Authors: W.h. Schreurs, J.r. Juttmann, W.n.h.m. Stuifbergen, H.j.m. Oostvogel, T.j.m.v. Vroonhoven
    Abstract:

    Background: Common Bile Duct stones are still a frequent problem. Although new diagnostic and therapeutic techniques are continually being development, they remain poorly defined. Therefore, we decided to evaluate our standard method of diagnosing and treating Common Bile Duct stones. The aim of the study was to determine the short- and long-term results of this method. Methods: Between 1985 and 1995, 552 consecutive patients (200 men and 352 women; median age, 69 years) underwent endoscopic retrograde cholangiography (ERC) because of suspected Common Bile Duct stones. If stones were detected, they were treated endoscopically, if possible. The results and complications of this policy were recorded. Patients were followed 1–13 years after undergoing ERC and endoscopic sphincterotomy (ES). Long-term results and complications during this period were also recorded. Results: ERC was attempted in 552 patients and succeeded in 510 patients (92%): ES was attempted in 315 patients and failed in five (98%). Duct clearance was done in 271 patients; in 26 of these patients, symptoms disappeared spontaneously. Ten patients underwent Common Bile Duct exploration. Complications occurred in 46 patients (8.3%). Mortality was 0.4%, hemorrhage occurred in 3.6%, pancreatitis in 1.4%, sepsis and cholangitis also in 1.4%, and the lithotripter basket became impacted in four patients (0.8%), necessitating to Common Bile Duct exploration. During follow-up, 45 patients (8%) returned, 35 with recurrent stones, five with cholangitis, two with stenosis of the papilla of Vater, and one with biliary pancreatitis. In 35 cases, complications were treated endoscopically, Common Bile Duct exploration was performed in five cases, and symptoms disappeared spontaneously in five cases. Conclusions: ERC is a safe and reliable way of diagnosing Common Bile Duct stones, and ES is a very efficient way of treating them. Morbidity and mortality are low, and the long-term results are very good.

S. Ebner - One of the best experts on this subject based on the ideXlab platform.

  • Laparoscopic management of Common Bile Duct stones
    Surgical Endoscopy And Other Interventional Techniques, 2004
    Co-Authors: S. Ebner, J. Rechner, S. Beller, K. Erhart, F. M. Riegler, G. Szinicz
    Abstract:

    Background While laparoscopic cholecystectomy is widely accepted for therapy of cholecystolithiasis, controversy still exists concerning the management of Common Bile Duct stones. Besides preoperative endoscopic papillotomy followed by laparoscopic cholecystectomy and open Common Bile Duct surgery, management of Common Bile Duct stones can be conDucted by laparoscopy, if respective experience is available. Method During laparoscopic cholecystectomy a cholangiography via the cystic Duct is routinely performed. If Bile Duct stones are detected they are retrieved via the cystic Duct or via incision of the Common Bile Duct by insertion of a Fogarty catheter or Dormia basket. Exclusion criteria against simultaneous laparoscopic management include suspicion of malignancy, severe pancreatitis, or cholangitis. Results From November 1991 to March 2002, 200 patients primarily underwent laparoscopic therapy of Bile Duct stones. Retrieval was performed via cystic Duct and Common Bile Duct incision in 115 and 85 cases, respectively. Complete removal was achieved in 91%; complication rate and mortality was 7% and 0.5%, respectively. During the same period primary endoscopic papillotomy was necessary in 40 patients because of the above contraindications. Conclusions When correct indications and surgical expertise are observed, simultaneous laparoscopic management of Common Bile Duct stones represents a safe and minimally invasive alternative to a two-procedure approach.

  • Laparoscopic management of Common Bile Duct stones
    Surgical endoscopy, 2004
    Co-Authors: S. Ebner, J. Rechner, S. Beller, K. Erhart, F. M. Riegler, G. Szinicz
    Abstract:

    Background While laparoscopic cholecystectomy is widely accepted for therapy of cholecystolithiasis, controversy still exists concerning the management of Common Bile Duct stones. Besides preoperative endoscopic papillotomy followed by laparoscopic cholecystectomy and open Common Bile Duct surgery, management of Common Bile Duct stones can be conDucted by laparoscopy, if respective experience is available.