1. The southwestern surgical congress multi-center trial on suspected common duct stones
- Author
-
Brandon R. Bruns, Brandon T. Grover, Sharmila Dissanaike, John C Stivers, Clay Cothren Burlew, Stephanie D. Gordy, Richard C. Frazee, Megan L. Swope, Rob Todd, Shanu N. Kothari, Divya Vangipurum, Emma Callaghan, Robert C. McIntyre, Michael S. Truitt, Justin L. Regner, Amy M. Kwok, Chris Cibari, Frank Wright, Lindsay O'Meara, Thomas J Schroeppel, Elizabeth P. Scherer, Vaidehi Agrawal, Julie Dunn, and Christopher Crane
- Subjects
Adult ,Male ,Endoscopic ultrasound ,medicine.medical_specialty ,Cholangiopancreatography, Magnetic Resonance ,medicine.medical_treatment ,030230 surgery ,Common duct stones ,Endosonography ,03 medical and health sciences ,0302 clinical medicine ,Southwestern United States ,medicine ,Humans ,Cholecystectomy ,Practice Patterns, Physicians' ,Aged ,Retrospective Studies ,Aged, 80 and over ,Cholangiopancreatography, Endoscopic Retrograde ,medicine.diagnostic_test ,business.industry ,Common Duct ,General surgery ,Interventional radiology ,General Medicine ,Middle Aged ,Endoscopy ,Choledocholithiasis ,030220 oncology & carcinogenesis ,Female ,Surgery ,Bilirubin levels ,Liver function tests ,business - Abstract
Choledocholithiasis is present in up to 15% of cholecystectomy patients. Treatment can be surgical, endoscopic, or via interventional radiology. We hypothesized significant heterogeneity between hospitals exists in the approach to suspected common duct stones.A retrospective review of patients that had a preoperative MRCP, endoscopic ultrasound, endoscopic retrograde cholangiopancreatogram (ERCP), or intra-operative cholangiogram was performed. Comparisons were by Wilcoxon-Mann-Whitney tests with significance of p 0.05 for paired variables and p 0.017 for multiple comparisons.Twelve participating institutions identified 1263 patients (409 men and 854 women) with a median age of 49 years (IQR: 31-94). Liver function tests (LFT's) were elevated in 939 patients (75%), median bilirubin level 1.75 mg/dl (IQ: 0.8-3.7 mg/dl) and median common duct size 7 mm (IQR 5-10 mm). The most common initial procedure was cholecystectomy with IOC at seven institutions, endoscopy at four and MRCP at one.Significant variation exists within the surgical community regarding suspected common duct stones. These results underscore the need for a protocol for common duct stones to minimize multiple, redundant interventions.
- Published
- 2019