Gallstone disease other imaging findings
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
Overview
There are other imaging modalities that can be useful in diagnosing gallstone disease, these include; endoscopic retrograde cholangiopancreatography (ERCP), bile microscopy and oral cholecystography. It should be noted however, that some of these have been replaced by non-invasive, more advanced and less expensive imaging techniques.
Endoscopic retrograde cholangiopancreatography
Endoscopic retrograde cholangiopancreaticogram (ERCP) is an invasive procedure that requires technical expertise and often performed by inserting a tube into the common bile duct while the patient is sedated. Contrast material is then injected to allow visualization of the biliary tree. Traditionally, ERCP was not only diagnostic but is also therapeutic, so that if a stone was detected, it could be removed in the same sitting. The sensitivity of ERCP for choledocholithiasis is estimated to be 80 - 93%. ERCP has largely been replaced by MRCP and is now reserved for patients at a high risk of having a common bile duct stone, particularly with cholangitis.[1][2][3]
Bile microscopy
Patients whom exhibit symptoms of biliary colic where ultrasound fails to detect stones often turn to microscopic analysis of their bile as proof of microlithiasis. It has an overall sensitivity of 65 to 90 percent for identifying patients with gallstones.[5][6] The test detects traces of cholesterol crystals or bilirubinate granules. A high number of patients whom had clear ultrasounds had positive results on microscopy, however, the high sensitivity of tranabdominal ultrasonography has made the need for microscopy rare. [7][8]
Oral cholecystography
Oral cholecystography is rarely done since being replaced by the transabdominal ultrasound. It is still occasionally use prognostically to evaluate gall bladder function in obese patients on medical dissolution therapy such as ursodeoxycholic acid where a high quality ultrasound cannot be obtained.[9]
References
- ↑ Prat F, Amouyal G, Amouyal P, Pelletier G, Fritsch J, Choury AD, Buffet C, Etienne JP (1996). "Prospective controlled study of endoscopic ultrasonography and endoscopic retrograde cholangiography in patients with suspected common-bileduct lithiasis". Lancet. 347 (8994): 75–9. PMID 8538344.
- ↑ Gurusamy KS, Giljaca V, Takwoingi Y, Higgie D, Poropat G, Štimac D, Davidson BR (2015). "Endoscopic retrograde cholangiopancreatography versus intraoperative cholangiography for diagnosis of common bile duct stones". Cochrane Database Syst Rev (2): CD010339. doi:10.1002/14651858.CD010339.pub2. PMID 25719222.
- ↑ Tse F, Liu L, Barkun AN, Armstrong D, Moayyedi P (2008). "EUS: a meta-analysis of test performance in suspected choledocholithiasis". Gastrointest. Endosc. 67 (2): 235–44. doi:10.1016/j.gie.2007.09.047. PMID 18226685.
- ↑ "www.wikiwand.com".
- ↑ Delchier JC, Benfredj P, Preaux AM, Metreau JM, Dhumeaux D (1986). "The usefulness of microscopic bile examination in patients with suspected microlithiasis: a prospective evaluation". Hepatology. 6 (1): 118–22. PMID 3943777.
- ↑ Moskovitz M, Min TC, Gavaler JS (1986). "The microscopic examination of bile in patients with biliary pain and negative imaging tests". Am. J. Gastroenterol. 81 (5): 329–33. PMID 3706246.
- ↑ Sedaghat A, Grundy SM (1980). "Cholesterol crystals and the formation of cholesterol gallstones". N. Engl. J. Med. 302 (23): 1274–7. doi:10.1056/NEJM198006053022302. PMID 7366692.
- ↑ Gollish SH, Burnstein MJ, Ilson RG, Petrunka CN, Strasberg SM (1983). "Nucleation of cholesterol monohydrate crystals from hepatic and gall-bladder bile of patients with cholesterol gall stones". Gut. 24 (9): 836–44. PMC 1420078. PMID 6884818.
- ↑ Shea JA, Berlin JA, Escarce JJ, Clarke JR, Kinosian BP, Cabana MD, Tsai WW, Horangic N, Malet PF, Schwartz JS (1994). "Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease". Arch. Intern. Med. 154 (22): 2573–81. PMID 7979854.