Navigation Links
Exclusion of common bile duct stones prior to gallstone operations
Date:10/31/2007

CBDS occur in 7-20% of all patients undergoing a gallstone operation and may complicate the course of surgery. Although intraoperative x-ray investigation was routinely performed to diagnose CBDS in the pre-laparoscopic era, its use during the laparoscopic era has been debated. Consequently, other techniques for diagnosing CBDS have been introduced. For example, preoperative liver function test (LFT; s-bilirubin and s-ALP) results, if abnormal, might be diagnostic for CBDS. However, some patients might have normal LFT despite coexisting CBDS. Ultrasonography is the major diagnostic modality used to diagnose gallstones, but is less helpful for diagnosing CBDS. Computed tomography is rarely useful for diagnosing gallstones. Magnetic-resonance-cholangio-pancreatography (MRCP) has high specificity and sensitivity, with accuracy similar to that of ERCP (Endoscopic-Retrograde-Cholangio-Pancreatography), but its accuracy depends on the size and anatomical location of a gallstone. In addition, MRCP is not widely available, and unlike ERCP, does not allow the endoscopic extraction of stones. ERCP is the most common technique used for both the diagnosis and treatment of CBDS. It is, however, expensive, invasive, technically demanding and associated with small but significant morbidity.

In this article, 200 consecutive patients with symptomatic gallstones disease operated on by laparoscopic cholecystectomy were retrospectively included and followed up 2-24 months after surgery. Three simple and routinely performed diagnostic variables, i.e., clinical history of patient (history of jaundice, pancreatitis or cholangitits), abnormal LFT results and/or dilated common bile duct (either alone or in combination), for diagnosing/excluding CBDS were evaluated. The results were statistically analyzed by calculating the sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) of each with special attention given to NPV, which is the proportion of patients with negative test results who are correctly diagnosed. Higher NPV indicates higher sensitivity for excluding CBDS.

Twenty five patients were found to have CBDS (12.5%). As a single diagnostic test, ultrasonography showed higher sensitivity, specificity, and negative/positive predictive values than both medical history and LFT. As a triple diagnostic modality, the combination of medical history, ultrasonographic findings, and LFT results was shown to be the best diagnostic modality to exclude CBDS (NPV of 97. 3 %).

The authors concluded that using a combination of three routinely used diagnostic components as a triple diagnostic modality can increase the diagnostic accuracy of CBDS. This test is recommended for excluding CBDS and to identify patients in need of other investigations, such as MRCP or ERCP. The availability and non-invasiveness of this triple diagnostic test are additional benefits.


'/>"/>

Contact: You-De Chang
y.d.chang@wjgnet.com
86-108-538-1892
World Journal of Gastroenterology
Source:Eurekalert

Related medicine news :

1. Developmental, neurologic problems common in extremely preterm infants
2. Iron supplementation for a common side effect
3. Genetic Breakthrough in Common Eye Problem
4. Common Cold Found to Fight Cancer Cells
5. Side Effects Of Some Common Drugs
6. E. coli strains resistant to a common antibiotic
7. Gastrointestinal ills more common in diabetics
8. Toxic effects common with AIDS treatments
9. Common contraception
10. Drooping eyelids more common in men
11. Unnatural death common in mentally ill
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/27/2016)... Overland Park, KS (PRWEB) , ... June 27, 2016 , ... ... leader in retailers of Eyeglasses . , Millions of individuals in the United ... life, eyeglasses have become a way to both correct vision and make a fashion ...
(Date:6/26/2016)... ... ... legally blind and certified personal trainer is helping to develop a weight loss fitness plan ... fix the two major problems leading the fitness industry today:, , ... They don’t eliminate all the reasons people quit their exercise program ...
(Date:6/25/2016)... ... June 25, 2016 , ... "With 30 hand-drawn hand gesture animations, FCPX users ... - CEO of Pixel Film Studios. , ProHand Cartoon’s package transforms over 1,300 ... Pro X . Simply select a ProHand generator and drag it above media or ...
(Date:6/25/2016)... ... June 25, 2016 , ... Conventional wisdom preaches the ... In terms of the latter, setting the bar too high can result in disappointment, ... just slow progress toward their goal. , Research from PsychTests.com reveals ...
(Date:6/24/2016)... ... June 24, 2016 , ... The ... in Dallas that it will receive two significant new grants to support its ... PHA marked its 25th anniversary by recognizing patients, medical professionals and scientists for ...
Breaking Medicine News(10 mins):
(Date:6/23/2016)... ITASCA, Ill. , June 23, 2016  In a startling ... states are failing their residents by lacking a comprehensive, proven plan ... , a definitive ranking of how states are tackling the ... rating to only four states – Kentucky , ... and Vermont . Of the 28 failing states, ...
(Date:6/23/2016)... , June 23, 2016 Bracket , a ... its next generation clinical outcomes platform, Bracket eCOA (SM) ... on June 26 – 30, 2016 in Philadelphia ... electronic Clinical Outcome Assessment product of its kind to fully ... Bracket eCOA 6.0 is a flexible platform for ...
(Date:6/23/2016)... -- Guerbet announced today that it has been named a ... One of 12 suppliers to receive the ... of Premier members through exceptional local customer service and ... lower costs. "We ... customer service from Premier," says Massimo Carrara , ...
Breaking Medicine Technology: