COMPARATIVE EVALUATION OF RADIOLOGICAL IMAGING RESULTS OF CHOLEDOCHOLITHIASIS IN PATIENTS WITH ACUTE CALCULOUS CHOLECYSTITIS

Kolomiytsev V. I., Terletskiy O. M., Bufan M. M.

METHODS AND METHODOLOGIES

Scentific article

Aim. To evaluate and compare diagnostic capabilities of transabdominal ultrasonography, magnetic resonance cholangiopancreatography, endoscopic ultrasonography, endoscopic retrograde cholangiopancreatography and computed tomography in the diagnosis of choledocholithiasis in patients with acute calculous cholecystitis. Object and methods. A prospective study included 377 patients who were treated in the period of 2015-2018 with an acute calculous cholecystitis and suspected choledocholithiasis. The mean age of patients was 56.4±15.11 years and ranged from 19 to 87; there were 96 male (25.5%) and 281 female (74.5%) patients. In addition to clinical and laboratory studies, all patients underwent transabdominal ultrasonography and endoscopic retrograde cholangiopancreatography, and if clinically indicated during diagnostics – computed tomography, magnetic resonance cholangiopancreatography, endoscopic ultrasonography. Results. Sensitivity of transabdominal ultrasonography in the diagnosis of large (16-20 mm) stones was 83.3%, small ones (3-6 mm) – 52.3%, and overall diagnostic accuracy – 83.5%. The diagnostic capabilities of computed tomography with small stones are not higher than of transabdominal ultrasonography. Magnetic resonance cholangiopancreatography is not sufficiently sensitive (79.2%) for stones of 3-6 mm in size. Endoscopic ultrasonography is characterized by high informative value (sensitivity to small (3-6 mm) stones was 95.2%, overall sensitivity of 96.0%, overall diagnostic accuracy of 99.1%) and compares by informative value to endoscopic retrograde cholangiography. Conclusions. Transabdominal ultrasonography and computed tomography do not have high quality indices in the diagnosis of choledocholithiasis in patients with acute cholecystitis. Magnetic resonance cholangiopancreatography has high sensitivity, specificity, and diagnostic accuracy. Endoscopic ultrasonography is recommended only after using all the capabilities of non-invasive diagnostic techniques to confirm choledocholithiasis in patients with clinical and laboratory signs of the disease before the therapeutic intervention.

choledocholithiasis, transabdominal ultrosonography, computed tomography, magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography, endoscopic ultrasonography.

1. Abraham S, Rivero HG, Erlikh IV, Griffith LF, Kondamudi VK. Surgical and nonsurgical management of gallstones. Am Fam Physician. 2014 May 15;89(10):795-802. PMID: 24866215.
2. Mamchych VI, Holovin AV, Yosypenko MA. Osoblyvosti diahnostyky mini-kholedokholytyaza. Khirurhiya Ukrayiny. 2014;3(03):50-4. [in Russian].
3. Kolomiitsev VI, Palamarchuk YuO, Dovhan YuP, Zhemela VH. Porivnialnyi analiz vykorystannia riznykh metodiv promenevoi diahnostyky kholedokholitiazu. Ukr. radiol. zhurn. 2013;4(21):390-9. [in Ukrainian].
4. Al-Jiffry BO, Elfateh A, Chundrigar T, Othman B, Almalki O, Rayza F, et al. Non-invasive assessment of choledocholithiasis in patients with gallstones and abnormal liver function. World J Gastroenterol. 2013 Sep 21;19(35):5877-82. DOI: 10.3748/wjg.v19.i35.5877
5. Judy Mary Kurian, Ganesh K, Praveen Kumar John, Prasad Hegde, Chidananda Murthy, Arun Kumar. A Comparative Evaluation of USG and MRCP Findings in Biliary and Pancreatic Pathologies. IJCMR. 2017 Jan;4(1):212-5.
6. Taha Ahmed M. Alkarboly, Salah Mohamad Fatih, Hiwa Abubaker Hussein, Talar M. Ali, Heero Ismael Faraj. The Accuracy of Transabdominal Ultrasoundin Detection of the Common Bile Duct Stoneas Compared to Endoscopic Retrograde Cholangiopancreatography (with Literature Review). OJGas. 2016 Jan 06(10):275-99. DOI: 10.4236/ojgas.2016.610032
7. Jaideep Darira, Junaid Iqbal, Sadia Rashid, Irfan Amjad Lufti, Saifullah, Muhammad KashifShazlee, et al. Diagnostic Accuracy of Magnetic Resonance Cholangiopancreatography (MRCP) in Choledocholithiasis Taking Endoscopic Retrograde Cholangiopancreatography (ERCP) as Gold Standard. EC Dent Sci 6.5. 2016: 1386-91.
8. Goldman L, Schafer AI. Goldman’s Cecil Medicine, 24th ed. USA, Elsevier 2015.
9. Smith ZL, Meiselman MS, Bope ET, Kellerman RD. Calculous biliary disease. Conn’s current therapy. Philadelphia (PA): Elsevier Saunders; 2013. р. 500-3.
10.  Kwon CI, Song SH, Hahm KB, Ko KH. Unusual complications related to endoscopic retrograde cholangiopancreatography and its endoscopic treatment. Clin Endosc. 2013 May;46(3):251-9. DOI: 10.5946/ce.2013.46.3.251
11. Morris S, Gurusamy KS, Sheringham J, Davidson BR. Cost-effectiveness analysis of endoscopic ultrasound versus magnetic resonance cholangiopancreatography in patients with suspected common bile duct stones. PLoS One. 2015 Mar 23;10(3):e0121699. DOI: 10.1371/journal. pone.0121699
12. Meeralam Y, Al-Shammari K, Yaghoobi M. Diagnostic accuracy of EUScompared with MRCP in detecting choledocholithiasis: a meta-analysis of diagnostic test accuracy in head-to-head studies. Gastrointest Endosc. 2017 Dec;86(6):986-93. DOI: 10.1016/j.gie.2017.06.009
13.  Prachayakul V, Aswakul P, Bhunthumkomol P, Deesomsak M. Diagnostic yield of endoscopic ultrasonography in patients with intermediate or high likelihood of choledocholithiasis: a retrospective study from one university-based endoscopy center. BMC Gastroenterol. 2014 Sep 26;14:165. DOI: 10.1186/1471-230X-14-165
14. Dronov AI, Nastashenko IL, Nastashenko AI, Voronjak AH. Rentgenhirurgicheskie vmeshatel’stva pri neblastomatoznoj biliarnoj obstrukcii. Hirurgija Ukrainy. 2013;2:29-34. [in Russian].
15. Giljaca V, Gurusamy KS, Takwoingi Y, Higgie D, Poropat G, Štimac D, et al. Endoscopic ultrasound versus magnetic resonance cholangiopancreatography for common bile duct stones. Cochrane Database Syst Rev. 2015 Feb 26;(2):CD011549. DOI: 10.1002/14651858.CD011549

«Bulletin of problems biology and medicine» Issue 2 Part 1 (150), 2019 year, 236-242 pages, index UDK 616.366-002-003.7-036.11:616.366/.367-073.75].001.36

10.29254/2077-4214-2019-2-1-150-236-242