Problems of modern diagnostics of choledocholithiasis
Abstract
The aim of review. To discuss issues of diagnostics of choledocholithiasis at the present time.
Original positions. The relevance of early recognition of choledocholithiasis is determined by high frequency at patients with cholelithiasis and risk of development of life-threatening complications. Diagnostics of choledocholithiasis is based on clinical data, laboratory and instrumental tests. Instrumental methods of investigation differ by their information value and invasiveness. So, it is important to define prognostic criteria (clinical, biochemical and ultrasound), determining necessity of additional more invasive and expensive investigation of bile ducts. However estimation of diagnostic criteria suggested by different authors and their threshold values is ambiguous. Discordant opinions frequently lead both to underestimation of the role of clinical and laboratory data, and to unjustified application of invasive diagnostic methods.
Conclusion. Further studies are necessary to develop more rational and objective systems of diagnostics of choledocholithiasis.
About the Authors
S. G. Shapoval’yantsRussian Federation
T. B. Ardasenov
Russian Federation
D. A. Freydovich
Russian Federation
A. G. Mylnikov
Russian Federation
A. G. Pan’kov
Russian Federation
S. A. Budzinsky
Russian Federation
A. A. Nikonov
Russian Federation
References
1. Борисов А.Е., Земляной В.П., Непомнящая С.Л., Мосягин В.Б. Малоинвазивные технологии в лечении желчнокаменной болезни, осложненной поражением внепеченочных желчных путей и большого сосочка двенадцатиперстной кишки // Анн. хир. гепатол. – 2004.– Т. 9, № 2. – С. 22–30.
2. Ветшев П.С., Стойко Ю.М., Левчук А.Л., Бардаков В.Г. Возможности современных методов диагностики и обоснование лечебной тактики при механической желтухе // Вестн. хир. гастроэнтерол. – 2008.– № 2. – С. 24–32.
3. Галлингер Ю.И., Хрусталева М.В. Эндоскопическая механическая литотрипсия в лечении холедохолитиаза: Метод. руководство для врачей эндоскопистов, хирургов, гастроэнтерологов. – М., 2006.
4. Гальперин Э.И., Дедерер Ю.М. Нестандартные ситуации при операциях на печени и желчных путях. – М.: Медицина, 1987. – 334 с.
5. Дадвани C.А., Ветшев П.С., Шулутко А.М., ПрудковМ.И. Желчнокаменная болезнь. – М., 2000. – 105 с.
6. Еременко В.П., Майстренко Н.А., Нечай А.И. и др.Гепатобилиарная хирургия. – СПб, 1999. – С. 113–171.
7. Ильченко А.А. Постхолецистэктомический синдром: клинические аспекты проблемы // Гастроэнтерология. – 2006. – Т. 8, № 2. – С. 18–27.
8. Клименко Г.А. Холедохолитиаз: диагностика и оперативное лечение. – М.: Медицина, 2000. – 223 с.
9. Кочуков В.П. Синдром Мириззи – миф или реальность // Эндоскопическая хирургия: Материалы IX Всерос. съезда по эндоскоп. хирургии (Москва, 15–17 февраля 2006 г.). – 2006. – Т. 12, № 2. – С. 65.
10. Ланцов В.П., Карлова Н.А. Рентгенологическое исследование желчных путей. – Петрозаводск, 1988. –103 с.
11. Лейшнер У. Практическое руководство по заболеваниям желчных путей. – М.: Гоэтар-Медицина, 2001.– 264 с.
12. Нечай А.И., Стукалов В.В., Нечай И.А. Распознавание камней в нерасширенных желчных протоках // Хирургия. – 1998. – № 3. – С. 4–6.
13. Подымова С.А. Болезни печени: Руководство для врачей. – М.: Медицина, 1984. – 480 с.
14. Родионов В.В., Филимонов М.И., Могучев В.М. Калькулезный холецистит (осложненный механической желтухой). – М., 1991. – 320 с.
15. Руководство по хирургии желчных путей / Под ред. Э.И. Гальперина, П.С. Ветшева. – М., 2006. – 568 с.
16. Amouyal P., Amouyal G., Levy P. et al. Diagnosis of choledocholithiasis by endoscopic ultrasonography // Gastroenterology. – 1994. – Vol. 106, N4. – Р. 1062–1067.
17. Attasaranya S., Fogel E.L., Lehman G.A. Choledocholithiasis, ascending cholangitis, and gallstone pancreatitis // Med. Clin. North Am. – 2008. – Vol. 92, N 4. – Р. 925–960.
18. Barteau J.A., Castro D., Arregui M.E., Tetik C. A comparison of intraoperative ultrasound versus cholangiography in the evaluation of the common bile duct during laparoscopic cholecystectomy // Surg. Endosc. – 1995. – Vol. 9, N 5. – Р. 490–496.
19. Birth M., Ehlers K.U., Delinikolas K., Weiser H.F. Prospective randomized comparison of laparoscopic ultrasonography using a flexible-tip ultrasound probe and intraoperative dynamic cholangiography during laparoscopic cholecystectomy // Surg. Endosc. – 1998. – Vol. 12, N 1. – Р. 30–36.
20. Buscarini E., Tansini P., Vallisa D. et al. EUS for suspected choledocholithiasis: A prospective, controlled study // Gastrointest. Endosc. – 2003. – Vol. 57, N 4.– P. 510–518.
21. Cabada Giadas T., Sarria Octavio de Toledo L., Martinez-Berganza Asensio M.T. et al. Helical CT cholangiography in the evaluation of the biliary tract: application to the diagnosis of Choledocholithiasis // Abdom. Imaging . – 2002. – Vol. 27. – P. 61–70.
22. Canto M.I., Chak A., Stellato T., Sivak M.V. Endoscopic ultrasonography versus cholangiography for the diagnosis of choledocholithiasis // Gastrointest. Endosc. – 1998. – Vol. 47, N 6. – P. 439–448.
23. Chang L., Simon K.L., Stabile B.E. et al. Gallstone pancreatitis: A prospective study on the incidence of cholangitis and clinical predictors of retained common bile stones // Am. J. Gastroenterol. –1998. – Vol. 93, N 4.– P. 527–531.
24. Coté G.A., Ansstas M., Pawa R. et al. Difficult biliary cannulation: use of physician-controlled wire-guided cannulation over a pancreatic duct stent to reduce the rate of precut sphincterotomy // Gastrointest. Endosc. – 2010.– Vol. 71, N 2. – Р. 275–279.
25. Cotton P.B., Garrow D.A., Gallagher J., Romagnuolo J. Risk factors for complications after ERCP: a multivariate analysis of 11,497 procedures over 12 years // Gastrointest. Endosc. – 2009. – Vol. 70, N 1. – P. 80–88.
26. Förster S., Klar E. Common bile duct stones. Diagnostic and therapeutic management // Chirurg. – 2008. – Vol. 79, N 9. – P. 881–892.
27. Gibson R.N., Vincent J.M., Speer T. et al. Accuracy of computed tomographic intravenous cholangiography (CT-IVC) with iotroxate in the detection of choledocholithiasis // Eur. Radiol. – 2005. – Vol. 15. – P.1634–1642.
28. Horwood J., Akbar F., Davis K., Morgan R. Prospective evaluation of a selective approach to cholangiography for suspected common bile duct stones // Ann. R. Coll. Surg. Engl. – 2010. – Vol. 92, N 3. – Р. 206–210.
29. Huguier M., Bornet P., Charpak Y. Selective contraindications based on multivariable analysis for operative cholangiography in biliary lithiasis // Surg. Gynecol. Obstet. – 1991. – Vol. 172. – P. 470–474.
30. Kim H.J., Park D.I., Park J.H. et al. Multidetector computed tomography cholangiography with multiplanar reformation for the assessment of patients with biliary obstruction // J. Gastoenterol. Hepatol. – 2007.– Vol. 22. – P. 400–405.
31. Ko C.W., Lee S.P. Epidemiology and natural history of common bile duct stones and prediction of disease // Gastrointest. Endosc. – 2002. – Vol. 56, N 6. – P. 165–169.
32. Lein-Ray Mo, Kuo-Kuan Chang, Chun-Hsiang Wang et al. Preoperative endoscopic sphincterotomy in the treatment of patients with cholecystocholedocholithiasis // HPB Surgery. – 2002. – Vol. 9. – P. 191–195.
33. Notash A.Y., Salimi J., Golfam F. et al. Preoperative clinical and paraclinical predictors of choledocholithiasis // Hepatobiliary Pancreat. Dis. Int. – 2008. – Vol. 7, N 3. – P. 304–307.
34. Ohtani T., Kawai C., Shirai Y. et al. Intraoperative ultrasonography versus cholangiography during laparoscopic cholecystectomy: a prospective comparative study // J. Am. Coll. Surg. – 1997. – Vol. 185. – P. 274–282.
35. Onken J.E., Brazer S.R., Eisen G.M. et al. Predicting the presence of choledocholithiasis in patients with symtomatic cholelithiasis // Am. J. Gastroenter. – 1996. – Vol. 91, N 4. – P. 762–767.
36. Palazzo L. Wich test for common bile duct stones? Endoscopic and intraductal ultrasonography // Endoscopy. – 1997. – Vol. 29. – P. 655–665.
37. Polkowski M., Palucki J., Regula J. et al. Helical computed tomographic cholangiography versus endosonography for suspected bile duct stones: a prospective blinded study in non-jaundiced patients // Gut. – 1999. – Vol. 45. – P. 744–749.
38. Prat F., Meduri B., Ducot B. et al. Prediction of common bile duct stones by noninvasive tests // Ann. Surg. – 1999. – Vol. 229, N 3. – P. 362–368.
39. Rábago L., Guerra I., Moran M. et al. Is outpatient ERCP suitable, feasible, and safe? The experience of a Spanish community hospital // Surg. Endosc. – 2010. – Vol. 24, N 7. – Р. 1701–1706.
40. Roston A.D., Jacobson I. Evalution of the pattern liver tests and yield of cholangiography in symptomatic choledocholitiasis: a prospective study // Gastrointest. Endosc. –1997. – Vol. 45, N 5. – P. 394–400.
41. Santucci L., Natalini G., Sarpi L. et al. Selective endoscopic retrograde cholangiography and preoperative bile duct stone removal in patients scheduled for laparoscopic cholecystectomy: a prospective study // Am. J. Gastroenter. – 1996. – Vol. 91, N 7. – P. 1326–1331.
42. Scott I.R., Gibney R.G., Becker C.D. et al. The use of intravenous cholangiography in teaching hospitals: a survey // Gastrointest. Radiol. – 1989. – Vol. 14, N 2. – P. 148–150.
43. Sener M., Gelik G., Basak F. et al. A new scoring system to predict choledocholithiasis and the necessity for the ERCP // The Official Journal of the International Hepato Pancreato Biliary Association. 5-th European Congress of the IHPBA. – May 28–31. – 2003. – Istanbul, Turkey.
44. Sgourakis G., Dedemadi G., Stamatelopoulos A. et al. Predictors of common bile duct lithiasis in laparoscopic era // World J. Gastroenterol. – 2005. – Vol. 11, N 21. – Р. 3267–3272.
45. Sharma S.K., Larson K.A., Adler Z., Goldfarb M.A. Role of endoscopic retrograde cholangiopancreatography in the management of suspected choledocholithiasis // Surg. Endosc. – 2003. – Vol. 17. – P. 868–871.
46. Shiozawa S., Tsuchiya A., Kim D.H. et al. Useful predictive factors of common bile duct stones prior to laparoscopic cholecystectomy for gallstones // Hepatogastroenterology. – 2005. – Vol. 52, N 66. – P. 1662–1665.
47. Sugiyama M., Atomi Y. Endoscopic ultrasonography for diagnosing choledocholithiasis: a prospective comparative study with ultrasonography and computed tomography // Gastrointest. Endosc. – 1997. – Vol. 45, N 3. – P. 143–146.
48. Taylor T.V., Armstrong C.P., Rimmer S. et al. Prediction of choledocholithiasis using a pocket microcomputer // Br. J. Surg. – 1988. – Vol. 75. – P. 138–140.
49. Tekin A., Saygili M., Hafta A., Oztan S. Biliary stones and stenoses: diagnostic value of magnetic resonance cholangiography // Turk. J. Gastroenterol. – 2002. – Vol. 13, N 3. – Р. 139–145.
50. Tham T.C.K., Collins J.S.A., Watson R.G.P. et al. Diagnosis of common bile duct stones by intravenous cholangiodraphy: prediction by ultrasound and liver function tests compared with endoscopic retrograde cholangiography // Gastrointest. Endosc. – 1996. – Vol. 44, N 2. – P. 158–165.
51. Verma D., Kapadia A., Eisen G.M. et al. EUS vs MRCP for detection of Choledocholithiasis // Gastrointest. Endosc. – 2006. – Vol. 64, N 2. – P. 248–254.
Review
For citations:
Shapoval’yants S.G., Ardasenov T.B., Freydovich D.A., Mylnikov A.G., Pan’kov A.G., Budzinsky S.A., Nikonov A.A. Problems of modern diagnostics of choledocholithiasis. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2011;21(2):22-29. (In Russ.)
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