ArticleDigestive diseases and sciences2016
Management of Suspected Choledocholithiasis: A Decision Analysis for Choosing the Optimal Imaging Modality.
Article in Digestive diseases and sciences, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed, 19 citations in OpenAlex.
- Endoscopic Management of Benign Pancreaticobiliary Disorders.Journal of clinical medicine · 2025Review
- The Diagnostic Value of GGT-Based Biochemical Indicators for Choledocholithiasis with Negative Imaging Results of Magnetic Resonance Cholangiopancreatography.Contrast media & molecular imaging · 2022Article
- EUS and ERCP in the Same Session for Biliary Stones: From Risk Stratification to Treatment Strategy in Different Clinical Conditions.Medicina (Kaunas, Lithuania) · 2021Review
- Impacts on outcomes and management of preoperative magnetic resonance cholangiopancreatography in patients scheduled for laparoscopic cholecystectomy: for whom it should be considered?Annals of surgical treatment and research · 2020Article
- 'Do no harm': an intuitive decision tool to assess the need for gastrointestinal endoscopy.Endoscopy international open · 2019Article
- EUS and ERCP: A rationale categorization of a productive partnership.Endoscopic ultrasoundReview
Corrections and comments
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Authors and funding
3 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
aimsMagnetic resonance cholangiography (MRC), endoscopic ultrasound (EUS), and endoscopic retrograde cholangio-pancreatography (ERCP) all represent viable options to establish the diagnosis of choledocholithiasis. The aim of the study was to assess how the three imaging modalities perform in head-to-head comparisons and in what order to apply them when using these procedures sequentially.
methodsA threshold analysis using a decision tree was modeled to compare the costs associated with different imaging techniques of the biliary system in a patient with suspected cholestasis secondary to choledocholithiasis. The main outcome parameter was the pre-test probability of common bile duct (CBD) stones that would guide the physician towards starting the work-up with MRC or EUS versus going straight to ERCP as the primary procedure.
resultsFor low pre-test probabilities of CBD stones in the common bile duct, MRC represents the procedure of choice. For pre-test probabilities ranging between 40 and 91 %, EUS should be the preferred imaging modality. If CBD stones are suspected with an even higher pre-test probability, patients could go straight to ERCP as their first procedure. Low costs associated with any of the three procedures increase its range of applicability at the expense of the other competing imaging modalities.
conclusionsMRC, EUS, and ERCP should be used in sequence and dependent on the pre-test probability of choledocholithiasis.
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