Evaluation of predictors for choledocholithiasis and assessment of outcomes after treatment: A historical cohort study

Sam Joel, M (2014) Evaluation of predictors for choledocholithiasis and assessment of outcomes after treatment: A historical cohort study. Masters thesis, Christian Medical College, Vellore.


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BACKGROUND: Common bile duct (CBD) stones are seen in 5% to 10% of those undergoing cholecystectomy. Missed CBD stones pose a risk of recurrent symptoms of abdominal pain, pancreatitis, and cholangitis unless identified at presentation. Therefore identifying the key predictors at presentation is of great value. OBJECTIVES: 1. To study the clinical, laboratory and radiological findings of patients diagnosed with common bile duct stones. 2. To study the current practice of managing this condition in our tertiary care hospital (Christian Medical College and Hospital). 3. To obtain data of a one year follow up of these patients who had undergone treatment for choledocholithiasis. METHODS: Cohort of patients diagnosed with choledocholithiasis who presented to the outpatient clinic of Hepatic Pancreatic and Biliary Surgery, General Surgery and Gastroenterology departments at Christian Medical College, Vellore from July 2008 to June 2012 were included in the study, and one year follow up data was also collected. The presenting history, clinical examination, laboratory tests and radiological imaging in the patients were recorded in the performa. RESULTS: The management practice in this tertiary care centre along with the various relevant clinical, biochemical and imaging parameters were identified. Abdominal pain was the common complaint (76%). Jaundice was a significant predictor for failure of ERCP. Abdominal ultrasonography commonly showed CBD dilation (85.4%) and intrahepatic biliary radical dilatation. MRI was the most sensitive to demonstrate CBD stone (86.6%). ERCP was the primary modality of treatment. CBD exploration was the treatment of choice in case of failed ERCP and stone extraction. There were recurrent CBD stones in 5% of the follow-up population. DISCUSSION: The most common clinical presentation of choledocholithiasis was abdominal pain. The presence of a dilated common bile duct of above 10mm associated with intrahepatic biliary dilatation was the commonest initial radiological finding. Abdominal ultrasound was an effective modality to pick up common bile duct stones but MRI had the best sensitivity. ERCP appeared to be the effective and preferred primary intervention of choice with failure rates being more in those having jaundice and dilated bile ducts. Delay in laparoscopic cholecystectomy following ERCP lead to a higher conversion rate to an open procedure. Serum alkaline phosphatase appeared to the best marker on follow up.

Item Type: Thesis (Masters)
Uncontrolled Keywords: common bile duct stone ; common bile duct exploration ; endoscopic retrograde cholangiopancreatography (ERCP).
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 07 Jul 2018 02:40
Last Modified: 07 Jul 2018 02:40
URI: http://repository-tnmgrmu.ac.in/id/eprint/8692

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