Size of common bile duct stones on MRCP predicts likelihood of positive findings at ERCP

J. Reid, R. Dolan, M. Patel, R. Fleming, D. Young, A. Hair

Research output: Contribution to journalArticle

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Abstract

To ascertain if direct measurement of the size of common bile duct stones (CBD) on magnetic resonance cholangio-pancreatography (MRCP) can be used to predict the likelihood of a positive endoscopic retrograde cholangio-pancreatography (ERCP) result. Should we be carrying out ERCPs on all patients with CBD stones?  We retrospectively analysed the records of 1812 consecutive patients undergoing MRCP between November 2009 and November 2014 at the Victoria Infirmary. A measurable CBD stone was present in 383 patients, of whom 293 successfully underwent ERCP.  221 patients (75%) had stones demonstrated on ERCP. A receiver operating curve (ROC) was plotted correlating stone size with the likelihood of a positive ERCP result, and demonstrates that using a cut off of >4 mm as an indication for ERCP gives the mathematical best-fit correlation with a sensitivity of 83% (95% CI 78-88) and specificity of 66% (95% CI 53-77).   In our current practice, all patients with CBD stones at MRCP are considered for ERCP regardless of stone size. Our results would support the hypothesis that as size decreases the likelihood of spontaneous stone passage increases. Although the threshold of mathematical best compromise is >4 mm to minimise both type 1 and type 2 errors, we would favour a lower threshold of 2 mm above which ERCP is performed (sensitivity 98.65, 95% CI 96.1-99.7, specificity 25.71%, CI 16.0-37.6). For patients with stones measuring 2 mm or less, early operative intervention with intraoperative cholangiography to confirm duct clearance could be a suitable alternative.

Original languageEnglish
Number of pages4
JournalThe surgeon : Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
DOIs
Publication statusPublished - 10 Dec 2015

Fingerprint

Magnetic Resonance
Common Bile Duct
Likelihood
Magnetic Resonance Spectroscopy
Predict
Specificity
Clearance
Consecutive
Receiver
Cholangiography
Victoria
Endoscopic Retrograde Cholangiopancreatography
Minimise
Decrease
Curve
Mm
Alternatives
Demonstrate

Keywords

  • ERCP
  • MRCP
  • gallstones
  • CBD size
  • stone diameter

Cite this

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title = "Size of common bile duct stones on MRCP predicts likelihood of positive findings at ERCP",
abstract = "To ascertain if direct measurement of the size of common bile duct stones (CBD) on magnetic resonance cholangio-pancreatography (MRCP) can be used to predict the likelihood of a positive endoscopic retrograde cholangio-pancreatography (ERCP) result. Should we be carrying out ERCPs on all patients with CBD stones?  We retrospectively analysed the records of 1812 consecutive patients undergoing MRCP between November 2009 and November 2014 at the Victoria Infirmary. A measurable CBD stone was present in 383 patients, of whom 293 successfully underwent ERCP.  221 patients (75{\%}) had stones demonstrated on ERCP. A receiver operating curve (ROC) was plotted correlating stone size with the likelihood of a positive ERCP result, and demonstrates that using a cut off of >4 mm as an indication for ERCP gives the mathematical best-fit correlation with a sensitivity of 83{\%} (95{\%} CI 78-88) and specificity of 66{\%} (95{\%} CI 53-77).   In our current practice, all patients with CBD stones at MRCP are considered for ERCP regardless of stone size. Our results would support the hypothesis that as size decreases the likelihood of spontaneous stone passage increases. Although the threshold of mathematical best compromise is >4 mm to minimise both type 1 and type 2 errors, we would favour a lower threshold of 2 mm above which ERCP is performed (sensitivity 98.65, 95{\%} CI 96.1-99.7, specificity 25.71{\%}, CI 16.0-37.6). For patients with stones measuring 2 mm or less, early operative intervention with intraoperative cholangiography to confirm duct clearance could be a suitable alternative.",
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Size of common bile duct stones on MRCP predicts likelihood of positive findings at ERCP. / Reid, J.; Dolan, R.; Patel, M.; Fleming, R.; Young, D.; Hair, A.

In: The surgeon : Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland, 10.12.2015.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Size of common bile duct stones on MRCP predicts likelihood of positive findings at ERCP

AU - Reid, J.

AU - Dolan, R.

AU - Patel, M.

AU - Fleming, R.

AU - Young, D.

AU - Hair, A.

N1 - Copyright © 2015 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

PY - 2015/12/10

Y1 - 2015/12/10

N2 - To ascertain if direct measurement of the size of common bile duct stones (CBD) on magnetic resonance cholangio-pancreatography (MRCP) can be used to predict the likelihood of a positive endoscopic retrograde cholangio-pancreatography (ERCP) result. Should we be carrying out ERCPs on all patients with CBD stones?  We retrospectively analysed the records of 1812 consecutive patients undergoing MRCP between November 2009 and November 2014 at the Victoria Infirmary. A measurable CBD stone was present in 383 patients, of whom 293 successfully underwent ERCP.  221 patients (75%) had stones demonstrated on ERCP. A receiver operating curve (ROC) was plotted correlating stone size with the likelihood of a positive ERCP result, and demonstrates that using a cut off of >4 mm as an indication for ERCP gives the mathematical best-fit correlation with a sensitivity of 83% (95% CI 78-88) and specificity of 66% (95% CI 53-77).   In our current practice, all patients with CBD stones at MRCP are considered for ERCP regardless of stone size. Our results would support the hypothesis that as size decreases the likelihood of spontaneous stone passage increases. Although the threshold of mathematical best compromise is >4 mm to minimise both type 1 and type 2 errors, we would favour a lower threshold of 2 mm above which ERCP is performed (sensitivity 98.65, 95% CI 96.1-99.7, specificity 25.71%, CI 16.0-37.6). For patients with stones measuring 2 mm or less, early operative intervention with intraoperative cholangiography to confirm duct clearance could be a suitable alternative.

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M3 - Article

JO - The surgeon : Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

JF - The surgeon : Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

SN - 1479-666X

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