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:10/12/2017)... ... 12, 2017 , ... The American College of Medical Informatics (ACMI) will present ... the Opening Session of AMIA’s Annual Symposium in Washington, D.C. AMIA’s Annual Symposium ... Collen, a pioneer in the field of medical informatics, this prestigious award is presented ...
(Date:10/12/2017)... LOS ANGELES (PRWEB) , ... October 12, 2017 ... ... of Parsa Mohebi Hair Restoration, has recently contributed a medical article to the ... doctors, on cosmetictown.com. Dr. Mohebi’s article spotlights the hair transplant procedure known as ...
(Date:10/12/2017)... ... October 12, 2017 , ... On Saturday, October 21, the ... – Miles by Moonlight to raise money for the American Heart Association Heart Walk. ... , Teams will work together to keep their treadmills moving for 5 hours. Treadmills ...
(Date:10/12/2017)... BALTIMORE (PRWEB) , ... October 12, 2017 , ... ... average of $3,296 in property taxes a year. In some states—like New York, ... higher. , By contrast, many overseas retirement havens have extremely low property-tax rates, ...
(Date:10/12/2017)... ... October 12, 2017 , ... Vodori, Inc., ... promotional review platform at the Promotional Review Committee Compliance and Best Practices ... streamline the medical, legal, and regulatory review (MLR) process – which ensures ...
Breaking Medicine News(10 mins):
(Date:10/11/2017)... -- Caris Life Sciences ® , a leading innovator in ... medicine, today announced that St. Jude Medical Center,s Crosson ... as its 17 th member. Through participation with ... Institute will help develop standards of care and best ... cancer treatment more precise and effective. ...
(Date:10/11/2017)... CHICAGO , Oct. 11, 2017  Hill-Rom Holdings, ... its Aspen Surgical facility in Las Piedras, ... surgical scalpels and blades. ... confirmed that the facility sustained minor structural damage, temporary ... Hurricane Maria. Repairs have been completed, manufacturing operations have ...
(Date:10/10/2017)... , Oct. 10, 2017   West Pharmaceutical Services, ... solutions for injectable drug administration, today shared the results ... Adapter for improving the intradermal administration of polio vaccines. ... Vaccination Summit in May 2017 by Dr. Ondrej ... Department, World Health Organization (WHO), and recently published in ...
Breaking Medicine Technology: