Rudy Mrad, MD, Marita Salame, MD, Karim Al Annan, MD, Anthony Kerbage, MD, Donna Maria Abboud, MD, Farah Abdul Razzak, MD, Vitor Brunaldi, MD, PhD, Lea N. Sayegh, MD, Karl Hage, MD, Khushboo Gala, MBBS, Aliana Bofill-Garcia, MD, Ryan J. Law, DO, Andrew Storm, MD, Vinay Chandrasekhara, MD, Barham Abu Dayyeh, MD, MPH, Eric J. Vargas, MD, MS Mayo Clinic, Rochester, MN
Introduction: Magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS) are both highly valuable tools in the evaluation of choledocholithiasis (CDL). MRCP is usually preferred as a first-line option because of its non-invasive nature. Nevertheless, choledocholithiasis in patients with a history of cholecystectomy (CCY) may have differing stone composition which may impact the sensitivity of MRCP and EUS. The aim of this study is to compare the sensitivity of MRCP and EUS to detect choledocholithiasis in patients post-CCY and highlight the implications that would have on post-CCY CDL guidelines.
Methods: We conducted a retrospective chart review of electronic medical records of patients with CDL with a prior history of cholecystectomy. ERCP (Endoscopic Retrograde Cholangiopancreatography) was considered the gold standard for choledocholithiasis detection. We included patients with a history of CCY with positive ERCP, who have undergone MRCP, EUS, or both. Baseline demographics were reported, and sensitivities of MRCP and EUS were calculated. Continuous variables were reported as mean ± standard deviation (SD), while categorical variables were reported as frequencies (%).
Results: A total of 30 patients were found to have CDL via ERCP in a post-CCY setting. 19 had undergone MRCP alone, 7 EUS alone, and 4 both. The sensitivity of MRCP was 78.26%, and the sensitivity of EUS was 91.67%.
Discussion: EUS had a higher sensitivity in detecting stones in this population, suggesting it could replace or complement MRCP as a first-line diagnostic tool in post-CCY patients. Despite the anesthesia requirement with EUS, it can significantly reduce false negative results. The role of EUS and MRCP in those with subsequent negative ERCP for CDL is being conducted to expand on these findings. Large prospective studies would be necessary to confirm these findings and inform clinical practice.
Figure: Comparing sensitivity of MRCP and EUS
Disclosures:
Rudy Mrad indicated no relevant financial relationships.
Marita Salame indicated no relevant financial relationships.
Karim Al Annan indicated no relevant financial relationships.
Anthony Kerbage indicated no relevant financial relationships.
Donna Maria Abboud indicated no relevant financial relationships.
Farah Abdul Razzak indicated no relevant financial relationships.
Vitor Brunaldi indicated no relevant financial relationships.
Lea Sayegh indicated no relevant financial relationships.
Karl Hage indicated no relevant financial relationships.
Khushboo Gala indicated no relevant financial relationships.
Aliana Bofill-Garcia indicated no relevant financial relationships.
Ryan J. Law: boston scientific – Consultant. conmed – Consultant. medtronic – Consultant. uptodate – Royalties.
Barham Abu Dayyeh: Apollo Endosurgery – Consultant, Grant/Research Support. Aspire Bariatrics – Grant/Research Support. Boston Scientific – Consultant, Grant/Research Support. Cairn Diagnostics – Grant/Research Support. DyaMx – Consultant. Endogastric Solutions – Speakers Bureau. Endo-TAGSS – Consultant. GI Dynamics – Grant/Research Support. Johnson and Johnson – Speakers Bureau. Medtronic – Grant/Research Support. Olympus – Speakers Bureau. Spatz Medical – Grant/Research Support. USGI Medical – Consultant, Grant/Research Support.
Eric J. Vargas: Philips – Grant/Research Support.
Rudy Mrad, MD, Marita Salame, MD, Karim Al Annan, MD, Anthony Kerbage, MD, Donna Maria Abboud, MD, Farah Abdul Razzak, MD, Vitor Brunaldi, MD, PhD, Lea N. Sayegh, MD, Karl Hage, MD, Khushboo Gala, MBBS, Aliana Bofill-Garcia, MD, Ryan J. Law, DO, Andrew Storm, MD, Vinay Chandrasekhara, MD, Barham Abu Dayyeh, MD, MPH, Eric J. Vargas, MD, MS. P2272 - Detection of Choledocholithiasis After Cholecystectomy: Is EUS Superior to MRCP?, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
