This is the first randomized trial to evaluate the efficacy of intraoperative cholangiography (IOC) and magnetic resonance cholangiopancreatography (MRCP) in patients with suspected CBDS.
This unblinded, multicenter RCT was conducted at five swiss hospitals. Eligibility criteria were suspected CBDS. Patients were randomized to IOC and laparoscopic cholecystectomy (LC), followed by endoscopic retrograde cholangiopancreatography (ERCP) if needed, or MRCP followed by ERCP if needed, and LC. Primary outcome was length of stay (LOS), secondary outcomes were cost, stone detection, and complication rates.
122 Patients were randomised to the IOC Group (63) or the MRCP group (59). Median LOS for the IOC and the MRCP groups were 4 days IQR [3, 6] and [4, 6], with an estimated increase of LOS of 1.2 days in the MRCP group (p = 0.0799) in the linear model. Median cost in the IOC and MRCP groups were 10 473 Swiss Francs (CHF) and 10 801 CHF, respectively (p = 0.694). CBDS were found in 24 and 12 patients in the IOC and the MRCP groups, respectively (p = 0.0387). The complication rate did not differ between both groups.
There is equipoise between both pathways. IOC has a significantly higher diagnostic yield than MRCP.
Clinicaltrials.gov identifier NCT02351492: Radiological Investigation of Bile Duct Obstruction (RIBO).
HPB : the official journal of the International Hepato Pancreato Biliary Association. 2022 Jun 18 [Epub ahead of print]
Sebastian M Staubli, Christoph Kettelhack, Daniel Oertli, Urs von Holzen, Urs Zingg, Diana Mattiello, Robert Rosenberg, Robert Mechera, Ilan Rosenblum, Urs Pfefferkorn, Otto Kollmar, Christian A Nebiker
Clarunis, University Center for Gastrointestinal and Liver Disease Basel, Basel, Switzerland; Department of Surgery, Cantonal Hospital Baselland, Liestal, Switzerland; Clinical Service of HPB Surgery and Liver Transplantation, Royal Free London Hospital, NHS Foundation Trust, London, NW3 2QG, UK., Clarunis, University Center for Gastrointestinal and Liver Disease Basel, Basel, Switzerland., Department of Surgery, University Hospital Basel, Basel, Switzerland., Department of Surgery, University Hospital Basel, Basel, Switzerland; Harper Cancer Research Institute, Indiana University School of Medicine South Bend, South Bend, IN, United States; Goshen Center for Cancer Care, Goshen, IN, United States., Department of Surgery, Limmattal Hospital, Zurich-Schlieren, Switzerland., Department of Surgery, Cantonal Hospital Baselland, Liestal, Switzerland; Clinical Service of HPB Surgery and Liver Transplantation, Royal Free London Hospital, NHS Foundation Trust, London, NW3 2QG, UK., Clinical Service of HPB Surgery and Liver Transplantation, Royal Free London Hospital, NHS Foundation Trust, London, NW3 2QG, UK., Department of Surgery, Hospital Dornach, Dornach, Switzerland., Department of Surgery, Cantonal Hospital Aarau, Aargau, Switzerland. Electronic address: .