Omer Aziz1, Hutan Ashrafian2, Catherine Jones2, Leanne Harling2, Sacheen Kumar2, George Garas2, Thomas Holme3, Ara Darzi2, Emmanouil Zacharakis4, Thanos Athanasiou2. 1. Minimal Access Unit, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK. Electronic address: omer.aziz@christie.nhs.uk. 2. Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, London W2 1NY, UK. 3. Department of General Surgery, Lister Hospital, Coreys Mill Lane, Stevenage, Hertfordshire SG1 4AB, UK. 4. Department of Hepatobiliary Surgery, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK.
Abstract
BACKGROUND: Routine intra-operative cholangiography (IOC) during laparoscopic cholecystectomy is often not performed because of increased operative time, radiation, and failure rate. Laparoscopic ultrasound (LUS) is a less invasive alternative but studies comparing it to IOC have been of small sample size. This study aims to assess the diagnostic accuracy of LUS in detecting common bile duct (CBD) stones compared to IOC. METHODS: This meta-analysis was executed and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) statement. 11 comparative studies (1994-2013) reporting on 12 patient groups were included. A bivariate model for diagnostic meta-analysis was used to attain overall pooled sensitivity and specificity for IOC and LUS, and their relationship assessed using a hierarchical summary receiver operating characteristic model with meta-regression. RESULTS: IOC had a pooled sensitivity of 0.87 (95% CI 0.77-0.93) and a pooled specificity of 0.99 (95% CI 0.98-0.99) with no significant heterogeneity. The diagnostic Odds Ratio (OR) was 442 (95% CI 196-997) and pooled weighted Area Under the Curve (AUC) was 0.99 (95% CI: 0.98-1.0). LUS had a pooled sensitivity of 0.87 (95% CI 0.80-0.92) and a specificity of 1.00 (95% CI 0.99-1.00). Heterogeneity was significant for specificity results. The diagnostic Odds Ratio (OR) was 1171 (95% CI 372-3689) and the pooled, weighted AUC was 1 (95% CI: 0.99-1). Meta-regression did not identify factors that significantly predict diagnostic accuracy. CONCLUSIONS: LUS is a potentially useful imaging modality to confirm the absence of CBD stones without needing to cannulate the biliary system.
BACKGROUND: Routine intra-operative cholangiography (IOC) during laparoscopic cholecystectomy is often not performed because of increased operative time, radiation, and failure rate. Laparoscopic ultrasound (LUS) is a less invasive alternative but studies comparing it to IOC have been of small sample size. This study aims to assess the diagnostic accuracy of LUS in detecting common bile duct (CBD) stones compared to IOC. METHODS: This meta-analysis was executed and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) statement. 11 comparative studies (1994-2013) reporting on 12 patient groups were included. A bivariate model for diagnostic meta-analysis was used to attain overall pooled sensitivity and specificity for IOC and LUS, and their relationship assessed using a hierarchical summary receiver operating characteristic model with meta-regression. RESULTS: IOC had a pooled sensitivity of 0.87 (95% CI 0.77-0.93) and a pooled specificity of 0.99 (95% CI 0.98-0.99) with no significant heterogeneity. The diagnostic Odds Ratio (OR) was 442 (95% CI 196-997) and pooled weighted Area Under the Curve (AUC) was 0.99 (95% CI: 0.98-1.0). LUS had a pooled sensitivity of 0.87 (95% CI 0.80-0.92) and a specificity of 1.00 (95% CI 0.99-1.00). Heterogeneity was significant for specificity results. The diagnostic Odds Ratio (OR) was 1171 (95% CI 372-3689) and the pooled, weighted AUC was 1 (95% CI: 0.99-1). Meta-regression did not identify factors that significantly predict diagnostic accuracy. CONCLUSIONS: LUS is a potentially useful imaging modality to confirm the absence of CBD stones without needing to cannulate the biliary system.
Authors: William W Hope; Robert Fanelli; Danielle S Walsh; Vimal K Narula; Ray Price; Dimitrios Stefanidis; William S Richardson Journal: Surg Endosc Date: 2017-03-31 Impact factor: 4.584
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Authors: S L Vlek; D A van Dam; S M Rubinstein; E S M de Lange-de Klerk; L J Schoonmade; J B Tuynman; W J H J Meijerink; M Ankersmit Journal: Surg Endosc Date: 2016-11-14 Impact factor: 4.584