Management of Suspected Choledocholithiasis

A Decision Analysis for Choosing the Optimal Imaging Modality

Amnon Sonnenberg, Brintha Enestvedt, Gennadiy Bakis

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background and Aims: Magneticresonance 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.

Original languageEnglish (US)
JournalDigestive Diseases and Sciences
DOIs
StateAccepted/In press - Sep 23 2015

Fingerprint

Choledocholithiasis
Decision Support Techniques
Cholangiography
Common Bile Duct
Costs and Cost Analysis
Decision Trees
Cholestasis
Biliary Tract
Physicians

Keywords

  • Biliary imaging
  • Cholestasis
  • Decision analysis
  • Endoscopic retrograde cholangio-pancreatography (ERCP)
  • Endoscopic ultrasound (EUS)
  • Magnetic resonance cholangiography (MRC)
  • Threshold analysis

ASJC Scopus subject areas

  • Gastroenterology
  • Physiology

Cite this

Management of Suspected Choledocholithiasis : A Decision Analysis for Choosing the Optimal Imaging Modality. / Sonnenberg, Amnon; Enestvedt, Brintha; Bakis, Gennadiy.

In: Digestive Diseases and Sciences, 23.09.2015.

Research output: Contribution to journalArticle

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