TY - JOUR
T1 - The southwestern surgical congress multi-center trial on suspected common duct stones
AU - Frazee, Richard
AU - Regner, Justin
AU - Truitt, Michael S.
AU - Agrawal, Vaidehi
AU - Swope, Megan
AU - Burlew, Clay Cothren
AU - Dissanaike, Sharmila
AU - Vangipurum, Divya
AU - Bruns, Brandon
AU - O'Meara, Lindsay
AU - Stivers, John
AU - Kwok, Amy
AU - Grover, Brandon T.
AU - Kothari, Shanu N.
AU - Cibari, Chris
AU - Dunn, Julie
AU - McIntyre, Robert C.
AU - Wright, Frank
AU - Scherer, Elizabeth P.
AU - Crane, Christopher
AU - Schroeppel, Thomas J.
AU - Callaghan, Emma
AU - Gordy, Stephanie
AU - Todd, Rob
N1 - Publisher Copyright:
© 2019
PY - 2019/6
Y1 - 2019/6
N2 - Background: Choledocholithiasis is present in up to 15% of cholecystectomy patients. Treatment can be surgical, endoscopic, or via interventional radiology. We hypothesized significant heterogeneity between hospitals exists in the approach to suspected common duct stones. Methods: A retrospective review of patients that had a preoperative MRCP, endoscopic ultrasound, endoscopic retrograde cholangiopancreatogram (ERCP), or intra-operative cholangiogram was performed. Comparisons were by Wilcoxon-Mann-Whitney tests with significance of p < 0.05 for paired variables and p < 0.017 for multiple comparisons. Results: Twelve participating institutions identified 1263 patients (409 men and 854 women)with a median age of 49 years (IQR: 31–94). Liver function tests (LFT's)were elevated in 939 patients (75%), median bilirubin level 1.75 mg/dl (IQ: 0.8–3.7 mg/dl)and median common duct size 7 mm (IQR 5–10 mm). The most common initial procedure was cholecystectomy with IOC at seven institutions, endoscopy at four and MRCP at one. Conclusion: Significant variation exists within the surgical community regarding suspected common duct stones. These results underscore the need for a protocol for common duct stones to minimize multiple, redundant interventions.
AB - Background: Choledocholithiasis is present in up to 15% of cholecystectomy patients. Treatment can be surgical, endoscopic, or via interventional radiology. We hypothesized significant heterogeneity between hospitals exists in the approach to suspected common duct stones. Methods: A retrospective review of patients that had a preoperative MRCP, endoscopic ultrasound, endoscopic retrograde cholangiopancreatogram (ERCP), or intra-operative cholangiogram was performed. Comparisons were by Wilcoxon-Mann-Whitney tests with significance of p < 0.05 for paired variables and p < 0.017 for multiple comparisons. Results: Twelve participating institutions identified 1263 patients (409 men and 854 women)with a median age of 49 years (IQR: 31–94). Liver function tests (LFT's)were elevated in 939 patients (75%), median bilirubin level 1.75 mg/dl (IQ: 0.8–3.7 mg/dl)and median common duct size 7 mm (IQR 5–10 mm). The most common initial procedure was cholecystectomy with IOC at seven institutions, endoscopy at four and MRCP at one. Conclusion: Significant variation exists within the surgical community regarding suspected common duct stones. These results underscore the need for a protocol for common duct stones to minimize multiple, redundant interventions.
KW - Choledocholithiasis
KW - Common duct exploration
KW - ERCP
KW - MRCP
UR - https://www.scopus.com/pages/publications/85059850779
UR - https://www.scopus.com/pages/publications/85059850779#tab=citedBy
U2 - 10.1016/j.amjsurg.2018.12.062
DO - 10.1016/j.amjsurg.2018.12.062
M3 - Article
C2 - 30654919
AN - SCOPUS:85059850779
SN - 0002-9610
VL - 217
SP - 1006
EP - 1009
JO - American journal of surgery
JF - American journal of surgery
IS - 6
ER -