Pre-operative MRCP: is it necessary before routine laparoscopic cholecystectomy to exclude CBD stone-prospective study in tertiary care hospital

Ganni Bhaskara Rao, Samir Ranjan Nayak, Sepuri Bala Ravi Teja, Reshma Palacharla


Background: Cholelithiasis is a common disease and at present the laparoscopic cholecystectomy is the gold standard treatment. The diagnosis of associated common bile duct stone for patients with gallstones is important for prompt surgical decision, treatment efficacy and patient safety. However, whether upper abdominal ultrasound and Liver function test (LFT) is adequate before doing lap cholecystectomy remains controversial. There are different opinions regarding the routine magnetic resonance cholangiopancreatography (MRCP) to detect the possible presence of common bile duct (CBD) stones before laparoscopic cholecystectomy.

Methods: This study was carried on a total of 106 patients who were admitted and treated for gall stone diseases in the Department of General Surgery, GSL General Hospital over a period of 24 months. After admission all cases were subjected for liver function test, USG abdomen and MRCP. The collected observational data was analyzed.

Results: Among the 106 patients, a total of 17cases showed concurrent gallstones and choledocholithiasis, 11 cases choledocholithiasis were revealed by ultrasound examination, while 6 cases of choledocholithiasis were not detected by ultrasound examination but were confirmed by MRCP.

Conclusions: CBD stone may be missed even in the presence of deranged liver enzymes or dilated CBD in USG abdomen. Hence for patient safety routine preoperative MRCP examination is recommended before doing laparoscopic cholecystectomy to rule out the likelihood of concomitant CBD stones. The cost-effectiveness of such expensive investigation is to be studied further taking into consideration preventive costs and patient morbidity and mortality.


CBD stone, Cholelithiasis, LFT, Magnetic resonance cholangiopancreatography, USG abdomen

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Mcfadden DW, Nigam A. Choledocholithiasis and cholangitis. In: Zinner Mj, Ashley SW. eds. Maingot’s abdominal operaions.11th Edn. Mcgraw-Hill; 2007:865-879.

Barbara L, Sama C, Morselli Labate AM, Taroni F, Rusticali AG, Festi D, et al. A population study on the prevalence of gallstone disease: the Sirmione Study. Hepatol. 1987;7(5):913-7.

Isherwood J, Garcea G, Williams R, Metcalfe M, Dennison A. Serology and ultrasound for diagnosis of choledocholithiasis. Ann R Coll Surg Engl. 2014;96(3):224-8.

Gurusamy KS, Giljaca V, Takwoingi Y, Higgie D, Poropat G, Štimac D, et al. Ultrasound versus liver function tests for diagnosis of common bile duct stones. The Cochrane Library; 2015.

Peng WK, Sheikh Z, Paterson-Brown S, Nixon SJ. Role of liver function tests in predicting common bile duct stones in acute calculous cholecystitis. Br J Surg. 2005;92(10):1241-7.

Ferrari FS, Fantozzi F, Tasciotti L, Vigni F, Scotto F, Frasci P. US, MRCP, CCT and ERCP: a comparative study in 131 patients with suspected biliary obstruction. Med Sci Monit. 2005;11(3):MT8-18.

Singh A, Mann HS, Thukral CL, Singh NR. Diagnostic Accuracy of MRCP as Compared to Ultrasound/CT in Patients with Obstructive Jaundice. J Clin Diagn Res. 2014;8(3):103-7.

Yaghoobi M, Meeralam Y, Al-Shammari K. Diagnostic accuracy of EUS compared with MRCP in detecting choledocholithiasis: a meta-analysis of diagnostic test accuracy of head-to-head studies Gastrointest Endosc. 2017.

Mandelia A, Gupta AK, Verma DK, Sharma S. The Value of Magnetic Resonance Cholangio-Pancreatography (MRCP) in the Detection of Choledocholithiasis. J Clin Diagn Res. 2013;7(9):1941-5.

Hoffmann C, Trebing G, Meyer L, Scheele J. Value and sensitivity of abdominal ultrasound in preoperative histologic diagnosis before laparoscopic cholecystectomy. Zentralbl Chir. 1998;2:89-91.

Boys JA, Doorly MG, Zehetner J, Dhanireddy KK, Senagore AJ. Can ultrasound common bile duct diameter predict common bile duct stones in the setting of acute cholecystitis? Am J Surg. 2014;207(3):432-5.

KKats J, Raai M, Dijkstra AJ, Koster K, Ter Borg F, Hazenberg HJ, et al. Magnetic resonance cholangiopancreaticography as a diagnostic tool for common bile duct stones: a comparison with ERCP and clinical follow-up. Radiol Med. 2005;109(3):239-51.

Guarise A, Baltieri S, Mainardi P, Faccioli N. Diagnostic accuracy of MRCP in holedocholithiasis J Gastrointest Surg. 2013;17(5):863-71.

Rosseland AR, Glomsaker TB. Asymptomatic common bile duct stones. Eur J Gastroenterol Hepatol. 2000;12(11):1171-3.

Jarhult J. Is preoperative evaluation of the biliary tree necessary in uncomplicated gallstone disease? Results of a randomized trial J. Järhult Candinavian J Surg. 200594:31-3.

Epelboym I, Winner M, Allendorf JD. MRCP is not a cost-effective strategy in the management of silent common bile duct stones. J Gastrointest Surg. 2013;17(5):863-71.

Nebiker CA, Baierlein SA, Beck S, von Flüe M, Ackermann C, Peterli R. Is routine MR cholangiopancreatography (MRCP) justified prior to cholecystectomy? Langenbecks Arch Surg. 2009;394(6):1005-10.

Yan Q, Zhengpeng Y, Zhituo L, Weihui Z, d Dongbo X. Is preoperative MRCP necessary for patients with gallstones? An analysis of the factors related to missed diagnosis of choledocholithiasis by preoperative ultrasound BMC Gastroenterol. 2015;15:158.