title: Non-invasive assessment of choledocholithiasis in patients with gallstones and abnormal liver function.
abstract: OBJECTIVE
  To find a non-invasive strategy for detecting choledocholithiasis before cholecystectomy, with an acceptable negative rate of endoscopic retrograde cholangiopancreatography.
  
  
  METHODS
  All patients with symptomatic gallstones were included in the study. Patients with abnormal liver functions and common bile duct abnormalities on ultrasound were referred for endoscopic retrograde cholangiopancreatography. Patients with normal ultrasound were referred to magnetic resonance cholangiopancreatography. All those who had a negative magnetic resonance or endoscopic retrograde cholangiopancreatography underwent laparoscopic cholecystectomy with intraoperative cholangiography.
  
  
  RESULTS
  Seventy-eight point five percent of patients had laparoscopic cholecystectomy directly with no further investigations. Twenty-one point five percent had abnormal liver function tests, of which 52.8% had normal ultrasound results. This strategy avoided unnecessary magnetic resonance cholangiopancreatography in 47.2% of patients with abnormal liver function tests with a negative endoscopic retrograde cholangiopancreatography rate of 10%. It also avoided un-necessary endoscopic retrograde cholangiopancreatography in 35.2% of patients with abnormal liver function.
  
  
  CONCLUSIONS
  This strategy reduces the cost of the routine use of magnetic resonance cholangiopancreatography, in the diagnosis and treatment of common bile duct stones before laparoscopic cholecystectomy.
authors.affiliation: Bilal O Al-Jiffry, Owaid AlMalki, Fares Rayza, Mohammed Hatem, Department of Surgery, College of Medicine and Medical Sciences, Taif University, Taif 21947, Saudi Arabia.
authors.forename: Bilal O
authors.initials: BO
authors.lastname: Al-Jiffry
authors.forename: Abdeen
authors.initials: A
authors.lastname: Elfateh
authors.forename: Tariq
authors.initials: T
authors.lastname: Chundrigar
authors.forename: Bassem
authors.initials: B
authors.lastname: Othman
authors.forename: Owaid
authors.initials: O
authors.lastname: Almalki
authors.forename: Fares
authors.initials: F
authors.lastname: Rayza
authors.forename: Hashem
authors.initials: H
authors.lastname: Niyaz
authors.forename: Hesham
authors.initials: H
authors.lastname: Elmakhzangy
authors.forename: Mohammed
authors.initials: M
authors.lastname: Hatem
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D016009:Chi-Square Distribution; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D017081:Cholecystectomy, Laparoscopic; D042883:Choledocholithiasis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D003661:Decision Support Techniques; D005260:Female; D042882:Gallstones / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008111:Liver Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014463:Ultrasonography; D019564:Unnecessary Procedures; D055815:Young Adult
keywords: Choledocholithiasis; Endoscopic retrograde cholangiopancreatography; Laparoscopic cholecystectomy; Liver function tests; Magnetic resonance cholangiopancreatography; Obstructive jaundice