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The treatment of choice for acute cholecystitis is cholecystectomy performed as soon as possible after onset of symptoms. Up to 9-22% of patients undergoing cholecystectomy due to cholecystitis have common bile duct stones. Magnetic resonance cholangiopancreatography (MRCP) can aid in technical planning of the operation. Intraoperative cholangiography (IOC) is another method to assess anatomy and stones during operation. There is a lack of quality studies comparing findings of MRCP and IOC and effect on hospital admission.
The aim of this study is to systematically assess the quality of MRCP and IOC in acute cholecystitis, and observe the effect of routine MRCP on surgery outcomes, length of hospital stay, hospital admission costs, and evaluate whether routine IOC could be replaced by MRCP.
Background
The treatment of choice for acute cholecystitis is cholecystectomy performed as soon as possible after onset of symptoms. Early cholecystectomy within 4 days after onset of symptoms resulted in reduced costs, morbidity and shorter hospital stay than delayed cholecystectomy.
Preoperative magnetic resonance cholangiopancreatography ( MRCP) is usually performed if there is a clinical suspicion of common bile duct ( CBD) stones. CBD stones in acute cholecystitis can be found in up to 9-22% of cholecystectomized patients. MRCP in acute cholecystitis can aid in technical planning of laparoscopic cholecystectomy. The benefit of MRCP is the non-invasiveness of the technique with 85-95% sensitivity and 93%-97% specificity.There is a lack of good-quality prospective studies concerning the findings of MRCP and intraoperative cholangiography (IOC) in acute cholecystitis. The purpose of preoperative diagnosis of CBD stones is to facilitate adequate planning of CBD stone removal, which is preferably performed as a single-stage procedure.
In acute cholecystitis the cystic duct may be obliterated and thus cause cannulation difficulties . In these situations preoperative MRCP may give valuable information if CBD stones are present.
The aims of this study is:
All patients with clinically and radiologically proven acute cholecystitis during one year (2019) will form the study cohort. Ultrasound and MRCP are performed unless there are no contraindications. The quality of MRCP is systematically and independently evaluated by two experienced radiologists. Laparoscopic or open cholecystectomy is programmed and IOC is performed if feasible. The quality and technical success of IOC is recorded and the c-arm cholangiography is documented and stored in the hospital database. In case of common bile duct stones the operating surgeon will decide the policy of stone removal.
The onset of symptoms, hospital arrival, time from arrival to operation, laboratory values, operative details, 30 day morbidity and postoperative outcome are evaluated.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Patients with acute cholecystitis | All patients with acute cholecystitis are included in the study cohort during year 2019. MRCP and IOC will be performed to all patients whenever feasible. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Magnetic resonance cholangiography | Diagnostic Test | preoperative MRCP in acute cholecystitis before cholecystectomy |
|
| Measure | Description | Time Frame |
|---|---|---|
| MRCP quality | Comparing radiology interobserver findings of preoperative MRCP | Hospital admission |
| Measure | Description | Time Frame |
|---|---|---|
| Success of intraoperative cholangiography | number of performed intraoperative cholangiographies | 1 year |
| preoperative MRCP | proportion of patients with bile duct stones in MRCP |
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Inclusion Criteria:
• Clinically and radiologically confirmed acute cholecystitis
Exclusion Criteria:
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All patients in Central Finland Central Hospital district hospitalized and operated due to acute cholecystitis.
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| Name | Affiliation | Role |
|---|---|---|
| Anne Mattila, MD,PhD | Central Finland Hospital District | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Central Finland Central Hospital | Jyväskylä | 40620 | Finland |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 25422672 | Result | Campanile FC, Pisano M, Coccolini F, Catena F, Agresta F, Ansaloni L. Acute cholecystitis: WSES position statement. World J Emerg Surg. 2014 Nov 18;9(1):58. doi: 10.1186/1749-7922-9-58. eCollection 2014. | |
| 27741006 | Result | Roulin D, Saadi A, Di Mare L, Demartines N, Halkic N. Early Versus Delayed Cholecystectomy for Acute Cholecystitis, Are the 72 hours Still the Rule?: A Randomized Trial. Ann Surg. 2016 Nov;264(5):717-722. doi: 10.1097/SLA.0000000000001886. |
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| ID | Term |
|---|---|
| D041881 | Cholecystitis, Acute |
| ID | Term |
|---|---|
| D002764 | Cholecystitis |
| D005705 | Gallbladder Diseases |
| D001660 | Biliary Tract Diseases |
| D004066 | Digestive System Diseases |
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| Intraoperative cholangiography | Diagnostic Test | Intraoperative cholangiography in acute cholecystitis during cholecystectomy |
|
| 1 year |
| Intraoperative cholangiography | Number of patients with bile duct stones in intraoperative cholangiography | During operation |
| Conversion | proportion of patients with converted laparoscopic cholecystectomy | During operation |
| Timing of cholecystectomy | Time gap between onset of symptoms and cholecystectomy | hours |
| Timing of MRCP | Time gap between hospital admission and MRCP | hours |
| Complications | Surgical complications | 30 days |
| Length of hospital stay | number of days patients spent in hospital | days |
| 27649704 | Result | Blohm M, Osterberg J, Sandblom G, Lundell L, Hedberg M, Enochsson L. The Sooner, the Better? The Importance of Optimal Timing of Cholecystectomy in Acute Cholecystitis: Data from the National Swedish Registry for Gallstone Surgery, GallRiks. J Gastrointest Surg. 2017 Jan;21(1):33-40. doi: 10.1007/s11605-016-3223-y. Epub 2016 Sep 20. |
| 21762294 | Result | Videhult P, Sandblom G, Rudberg C, Rasmussen IC. Are liver function tests, pancreatitis and cholecystitis predictors of common bile duct stones? Results of a prospective, population-based, cohort study of 1171 patients undergoing cholecystectomy. HPB (Oxford). 2011 Aug;13(8):519-27. doi: 10.1111/j.1477-2574.2011.00317.x. Epub 2011 May 11. |
| 27847796 | Result | Lee DH, Ahn YJ, Lee HW, Chung JK, Jung IM. Prevalence and characteristics of clinically significant retained common bile duct stones after laparoscopic cholecystectomy for symptomatic cholelithiasis. Ann Surg Treat Res. 2016 Nov;91(5):239-246. doi: 10.4174/astr.2016.91.5.239. Epub 2016 Oct 31. |
| 22447440 | Result | Tonolini M, Ravelli A, Villa C, Bianco R. Urgent MRI with MR cholangiopancreatography (MRCP) of acute cholecystitis and related complications: diagnostic role and spectrum of imaging findings. Emerg Radiol. 2012 Aug;19(4):341-8. doi: 10.1007/s10140-012-1038-z. Epub 2012 Mar 25. |
| 14530225 | Result | Romagnuolo J, Bardou M, Rahme E, Joseph L, Reinhold C, Barkun AN. Magnetic resonance cholangiopancreatography: a meta-analysis of test performance in suspected biliary disease. Ann Intern Med. 2003 Oct 7;139(7):547-57. doi: 10.7326/0003-4819-139-7-200310070-00006. |
| 37578567 | Derived | Mattila A, Helminen O, Pynnonen E, Sironen A, Elomaa E, Nevalainen M. Preoperative MRCP Can Rule Out Choledocholithiasis in Acute Cholecystitis with a High Negative Predictive Value: Prospective Cohort Study with Intraoperative Cholangiography. J Gastrointest Surg. 2023 Nov;27(11):2396-2402. doi: 10.1007/s11605-023-05790-x. Epub 2023 Aug 14. |