Introduction Patients with CBD (Common Bile Duct) stones require high risk interventions. Around 10–20% patients with symptomatic gallstones have CBD stones. Where the initial clinical, biochemical and ultrasound examinations failed to correctly predict CBD stones in a patient with gall stones, one should resort to either MRCP or EUS (Endoscopic Ultrasound) depending on the local expertise. Without the availability of either national or local proposed strategy for these investigations we feel either test may be inappropriately used. Our aim was to study the clinical details of patients undergoing MRCP for the suspected CBD stones and assess for their appropriateness.
Methods We randomly selected 45 patients who underwent MRCP for suspected CBD stones in the last one year. We assigned the risk of choledocholithiasis based on ASGE (American Society Gastrointestinal Endoscopy) guidelines and compared with their suggested management strategy. Finally we assessed their appropriateness based on the predictive factors and MRCP findings.
Results There were 28 females and 17 males. The age range was 21 to 91 years (mean 63.7 yrs). Based on the ASGE guidelines we assigned 24 (53.33%) patients to intermediate, 16 to low (35.55%) %) and 5(11.11%) to high likelihood of choledocholithiais based on clinical predictors. Only 6 patients (13.33%) had choledocholithiasis on MRCP three in high risk (3/5), 3(3/24) in intermediate risks and none (0/16) in low risk group
Conclusion Our audit suggests inappropriate use of MRCP in patients with low predictable group (35%). We feel those patients with high predictability should be carefully considered directly for ERCP. Currently we are extending this audit and also plan to re-audit after formulating local guidelines for the use of MRCP in suspected bile duct stones. We feel with careful clinical judgement, MRCP can be used selectively in those patients where it is going to be more useful and saving these radiological slots for more needy patients in a busy DGH.
Disclosure of Interest None Declared.
Guidelines on the management of common bile duct stones (CBDS) - BSG Guidelines July 2008
The role of endoscopy in the evaluation of suspected choledocholithiasis- ASGE Guidelines GI Endoscopy Vol 71, No 1 2010