Intraoperative ultrasound compared to magnetic resonance cholangiopancreatography in patients with suspected choledocholithiasis

Introduction: Laparoscopic ultrasound (LUS) has become a feasible and quick alternative to preoperative magnetic resonance cholangiopancreatography (MRCP) in patient with suspected choledocholithiasis. The aim of the study was to assess the diagnostic accuracy of LUS in detecting choledocholithiasis compared to preoperative MRCP. Materials and methods: This prospective study included urgently admitted patients with suspected choledocholithiasis during the period from August 2012 till June 2015. All patients were operated in laparoscopic technique and evaluated with LUS and according to availability part of them had preoperative MRCP. Main outcomes were analysed. Results: From all 193 patients 71 had biliary pancreatitis, 95 cholangitis, 113 jaundice, 86 acute cholecystitis and 71 developed sepsis. The median age of male patients was 65 years (IQR74-55) vs. 58 years (IQR68-45) in females, p = 0.007. Technically LUS was done successfully in all 193 patients. MRCP was not informative in 3 cases (5.6%) from 53. Detection of the common bile duct stones by LUS was successful in 119 patients (61.66%) vs. 24 by MRCP (45.28%), p = 0.041. MRCP was true positive in 23 patients and true negative in 14. The sensitivity and specificity of MRCP were 60.53% and 93.33% compared to 100% and 98.67% of LUS. Median hospital stay was significantly shorter in patients evaluated only with LUS compared to preoperative MRCP - 9 days (IQR11-6) vs. 12 days (IQR14-9), respectively, p < 0.001. Conclusion: LUS has become promising alternative as a primary imaging technique for detection of the choledocholithiasis and may replace the MRCP, if non-gallstone lesions are not suspected.