TY - JOUR
T1 - Management of Suspected Choledocholithiasis
T2 - A Decision Analysis for Choosing the Optimal Imaging Modality
AU - Sonnenberg, Amnon
AU - Enestvedt, Brintha K.
AU - Bakis, Gennadiy
N1 - Funding Information:
No financial support was received for this study. The authors have no personal interests to declare.
Publisher Copyright:
© 2015, Springer Science+Business Media New York (Outside the USA).
PY - 2016/2/1
Y1 - 2016/2/1
N2 - Background and Aims: Magnetic resonance cholangiography (MRC), endoscopic ultrasound (EUS), and endoscopic retrograde cholangio-pancreatography (ERCP) all represent viable options to establish the diagnosis of choledocholithiasis. The aim of the study was to assess how the three imaging modalities perform in head-to-head comparisons and in what order to apply them when using these procedures sequentially. Methods: A threshold analysis using a decision tree was modeled to compare the costs associated with different imaging techniques of the biliary system in a patient with suspected cholestasis secondary to choledocholithiasis. The main outcome parameter was the pre-test probability of common bile duct (CBD) stones that would guide the physician towards starting the work-up with MRC or EUS versus going straight to ERCP as the primary procedure. Results: For low pre-test probabilities of CBD stones in the common bile duct, MRC represents the procedure of choice. For pre-test probabilities ranging between 40 and 91 %, EUS should be the preferred imaging modality. If CBD stones are suspected with an even higher pre-test probability, patients could go straight to ERCP as their first procedure. Low costs associated with any of the three procedures increase its range of applicability at the expense of the other competing imaging modalities. Conclusions: MRC, EUS, and ERCP should be used in sequence and dependent on the pre-test probability of choledocholithiasis.
AB - Background and Aims: Magnetic resonance cholangiography (MRC), endoscopic ultrasound (EUS), and endoscopic retrograde cholangio-pancreatography (ERCP) all represent viable options to establish the diagnosis of choledocholithiasis. The aim of the study was to assess how the three imaging modalities perform in head-to-head comparisons and in what order to apply them when using these procedures sequentially. Methods: A threshold analysis using a decision tree was modeled to compare the costs associated with different imaging techniques of the biliary system in a patient with suspected cholestasis secondary to choledocholithiasis. The main outcome parameter was the pre-test probability of common bile duct (CBD) stones that would guide the physician towards starting the work-up with MRC or EUS versus going straight to ERCP as the primary procedure. Results: For low pre-test probabilities of CBD stones in the common bile duct, MRC represents the procedure of choice. For pre-test probabilities ranging between 40 and 91 %, EUS should be the preferred imaging modality. If CBD stones are suspected with an even higher pre-test probability, patients could go straight to ERCP as their first procedure. Low costs associated with any of the three procedures increase its range of applicability at the expense of the other competing imaging modalities. Conclusions: MRC, EUS, and ERCP should be used in sequence and dependent on the pre-test probability of choledocholithiasis.
KW - Biliary imaging
KW - Cholestasis
KW - Decision analysis
KW - Endoscopic retrograde cholangio-pancreatography (ERCP)
KW - Endoscopic ultrasound (EUS)
KW - Magnetic resonance cholangiography (MRC)
KW - Threshold analysis
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U2 - 10.1007/s10620-015-3882-7
DO - 10.1007/s10620-015-3882-7
M3 - Article
C2 - 26399621
AN - SCOPUS:84973444166
SN - 0163-2116
VL - 61
SP - 603
EP - 609
JO - American Journal of Digestive Diseases and Nutrition
JF - American Journal of Digestive Diseases and Nutrition
IS - 2
ER -