← Back to Search
Cost-effective Decisions In Detecting Silent Common Bile Duct Gallstones During Laparoscopic Cholecystectomy
Susie X. Sun, A. Kulaylat, C. Hollenbeak, D. Soybel
Published 2016 · Medicine
Download PDFAnalyze on Scholarcy
Objective:To evaluate the cost-effectiveness of routine intraoperative ultrasonography (IOUS), cholangiography (IOC), or expectant management without imaging (EM) for investigation of clinically silent common bile duct (CBD) stones during laparoscopic cholecystectomy. Background:The optimal algorithm for the evaluation of clinically silent CBD stones during routine cholecystectomy is unclear. Methods:A decision tree model of CBD exploration was developed to determine the optimal diagnostic approach based on preoperative probability of choledocholithiasis. The model was parameterized with meta-analyses of previously published studies. The primary outcome was incremental cost per quality-adjusted life year (QALY) gained from each diagnostic strategy. A secondary outcome was the percentage of missed stones. Costs were from the perspective of the third party payer and sensitivity analyses were performed on all model parameters. Results:In the base case analysis with a prevalence of stones of 9%, IOUS was the optimal strategy, yielding more QALYs (0.9858 vs 0.9825) at a lower expected cost ($311 vs $574) than EM. IOC yielded more QALYs than EM in the base case (0.9854) but at a much higher cost ($1122). IOUS remained dominant as long as the preoperative probability of stones was above 3%; EM was the optimal strategy if the probability was less than 3%. The percentage of missed stones was 1.5% for IOUS, 1.8% for IOC and 9% for EM. Conclusions:In the detection and resultant management of CBD stones for the majority of patients undergoing laparoscopic cholecystectomy, IOUS is cost-effective relative to IOC and EM.
This paper references
Laparoscopic ultrasonography versus intra-operative cholangiogram for the detection of common bile duct stones during laparoscopic cholecystectomy: a meta-analysis of diagnostic accuracy.
O. Aziz (2014)
Randomised trial of laparoscopic exploration of common bile duct versus postoperative endoscopic retrograde cholangiography for common bile duct stones
M. Rhodes (1998)
Laparoscopic cholecystectomy without routine operative cholangiography does not result in significant problems related to retained stones
D. J. Thornton (2001)
Prospective randomized trial of LC+LCBDE vs ERCP/S+LC for common bile duct stone disease.
S. Rogers (2010)
Selective cholangiography. Current role in laparoscopic cholecystectomy.
K. Lillemoe (1992)
Laparoscopic intraoperative biliary ultrasonography: findings during laparoscopic cholecystectomy for acute disease.
Jason M. Pfluke (2011)
Predictors of post-ERCP complications in patients with suspected choledocholithiasis.
S. Mehta (1998)
Is laparoscopic intraoperative cholangiogram a matter of routine?
M. Metcalfe (2004)
A Prospective Study of Common Bile Duct Calculi in Patients Undergoing Laparoscopic Cholecystectomy: Natural History of Choledocholithiasis Revisited
C. Collins (2004)
Meta-analysis of one- vs. two-stage laparoscopic/endoscopic management of common bile duct stones.
N. Alexakis (2012)
Biochemical predictors for absence of common bile duct stones in patients undergoing laparoscopic cholecystectomy
Ming-Hsun Yang (2007)
The utility of intracorporeal ultrasonography for screening of the bile duct during laparoscopic cholecystectomy
Jain-Wei Wu (2007)
Laparoscopic intracorporeal ultrasound versus fluoroscopic intraoperative cholangiography: after the learning curve.
V. Halpin (2002)
A prospective randomized trial of cannulation technique in ERCP: effects on technical success and post-ERCP pancreatitis.
A. Bailey (2008)
The routine use of laparoscopic ultrasound decreases bile duct injury: a multicenter study
J. Machi (2008)
A prospective comparison of laparoscopic ultrasound vs intraoperative cholangiogram during laparoscopic cholecystectomy
Jr. R. A. Falcone (1999)
Value of magnetic resonance cholangiopancreatography in the diagnosis of biliary abnormalities in postcholecystectomy patients: a probabilistic cost-effectiveness analysis of diagnostic strategies.
K. Howard (2006)
Cost utility of early versus delayed laparoscopic cholecystectomy for acute cholecystitis
A. Johner (2012)
Lower rate of major bile duct injury and increased intraoperative management of common bile duct stones after implementation of routine intraoperative cholangiography.
K. T. Buddingh (2011)
Systematic review of endoscopic ultrasonography versus endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis
M. S. Petrov (2009)
Mechanism of pancreatitis caused by ERCP.
R. Akashi (2002)
Laparoscopic ultrasonography is a complement to cholangiography for the detection of choledocholithiasis at laparoscopic cholecystectomy
J. Catheline (2002)
Is intraoperative cholangiography during laparoscopic cholecystectomy cost effective?
Y. Podnos (2001)
Preoperative evaluation of the risk of common bile duct stones.
F. Lacaine (1980)
Triple non-invasive diagnostic test for exclusion of common bile ducts stones before laparoscopic cholecystectomy.
B. Pourseidi (2007)
Prospective study of clinical and biochemical features of symptomatic choledocholithiasis
M. Anciaux (2005)
Laparoscopic ultrasound as the primary method for bile duct imaging during cholecystectomy
K. Perry (2007)
The role of cost-effectiveness analysis in health and medicine. Panel on Cost-Effectiveness in Health and Medicine.
L. Russell (1996)
Initial cholecystectomy vs sequential common duct endoscopic assessment and subsequent cholecystectomy for suspected gallstone migration: a randomized clinical trial.
P. Iranmanesh (2014)
Routine cholangiography is not warranted during laparoscopic cholecystectomy.
D. Clair (1993)
Guidelines for Pharmacoeconomic Studies
J. Siegel (2012)
Routine versus selective intraoperative cholangiography during laparoscopic cholecystectomy
A. Nickkholgh (2005)
Complications of ERCP: a prospective study.
M. Christensen (2004)
Useful Predictors of Bile Duct Stones in Patients Undergoing Laparoscopic Cholecystectomy
A. Barkun (1994)
Laparoscopic ultrasonography versus operative cholangiography during laparoscopic cholecystectomy: review of the literature and a comparison with open intraoperative ultrasonography.
J. Machi (1999)
Potential of laparoscopic ultrasonography as an alternative to operative cholangiography in the detection of bile duct stones
S. Tranter (2001)
Prospective evaluation of a selective approach to cholangiography for suspected common bile duct stones.
J. Horwood (2010)
Prediction of operative cholangiography in patients undergoing elective cholecystectomy with routine liver function chemistries.
P. Del Santo (1985)
Laparoscopic Ultrasonography as a Good Alternative to Intraoperative Cholangiography (IOC) during Laparoscopic Cholecystectomy: Results of Prospective Study
A. Hublet (2009)
Selective operative cholangiography.
H. Bogokowsky (1987)
Costs and Utilization of Intraoperative Cholangiography
E. Livingston (2007)
Systematic review of intraoperative cholangiography in cholecystectomy
J. Ford (2012)
Meta-Analysis, Decision Analysis, and Cost Effectiveness Analysis: Methods for Quantitative Synthesis in Medicine, 2nd Edition
P. Langenberg (2000)
Cost-effective treatment of patients with symptomatic cholelithiasis and possible common bile duct stones.
L. Brown (2011)
The era of ultrasonography during laparoscopic cholecystectomy.
R. Onders (2005)
Laparoscopic intracorporeal ultrasound versus fluoroscopic intraoperative cholangiography
V. Halpin (2001)
Prediction of common bile duct stones by noninvasive tests.
F. Prat (1999)
Laparoscopic cholangiography. The case for a selective approach.
D. Clair (1994)
Routine intraoperative laparoscopic ultrasonography with selective cholangiography reduces bile duct complications during laparoscopic cholecystectomy.
W. Biffl (2001)
Has intraoperative cholangiography during laparoscopic cholecystectomy become obsolete in the era of preoperative endoscopic retrograde and magnetic resonance cholangiopancreatography?
K. Sirinek (2015)
ON ESTIMATING THE RELATION BETWEEN BLOOD GROUP AND DISEASE
B. Woolf (1955)
Complications of diagnostic and therapeutic ERCP: a prospective multicenter study
E. Masci (2001)
Intra-operative vs pre-operative endoscopic sphincterotomy in patients with gallbladder and common bile duct stones
K. Gurusamy (2012)
Bile duct stones and laparoscopic cholecystectomy: a decision analysis to assess the roles of intraoperative cholangiography, EUS, and ERCP.
A. Sahai (1999)
Operative cholangiography in elective cholecystectomy
H. Pernthaler (1990)
The use of laparoscopic ultrasound in difficult cholecystectomy cases significantly decreases morbidity.
Elizabeth C. Gwinn (2013)
Incidence Rates of Post-ERCP Complications: A Systematic Survey of Prospective Studies
A. Andriulli (2007)
A prospective, randomized, placebo-controlled trial of transdermal glyceryl trinitrate in ERCP: effects on technical success and post-ERCP pancreatitis.
A. Kaffes (2006)
Preoperative bilirubin, alkaline phosphatase and amylase levels as predictors of common duct stones.
E. Saltzstein (1982)
Recommendations for Reporting Cost-effectiveness Analyses
J. Siegel (1996)
How reliable is intraoperative cholangiography as a method for detecting common bile duct stones?
P. Videhult (2008)
Surgical versus endoscopic treatment of bile duct stones.
B. Dasari (2013)
Intraoperative ultrasonography versus cholangiography during laparoscopic cholecystectomy: a prospective comparative study.
T. Ohtani (1997)
Prospective randomized study of routine intraoperative cholangiography during open cholecystectomy: long-term follow-up and multivariate analysis of predictors of choledocholithiasis.
M. Hauer-Jensen (1993)
Technical aspects of bile duct evaluation and exploration.
S. Orenstein (2014)
Management of Preoperatively Suspected Choledocholithiasis: A Decision Analysis
Bilal Kharbutli (2008)
Recommendations of the Panel on Cost-effectiveness in Health and Medicine.
M. Weinstein (1996)
Guidelines for pharmacoeconomic studies. Recommendations from the panel on cost effectiveness in health and medicine. Panel on cost Effectiveness in Health and Medicine.
J. Siegel (1997)
A cost-effectiveness analysis of intraoperative cholangiography in the prevention of bile duct injury during laparoscopic cholecystectomy.
D. Flum (2003)
Preoperative evaluation of the probability of common bile duct stones. French Association for Surgical Research.
T. Montariol (1995)
Preliminary experience with intracorporeal laparoscopic ultrasonography using a sector scanning probe
T. John (2004)
Improving ERCP quality and decreasing risk to patients and providers
Toufic Kachaamy (2013)
Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with concomitant gallbladder stones and common bile duct stones: a randomized controlled trial
V. Bansal (2013)
Guidelines on the management of common bile duct stones (CBDS)
E. Williams (2008)
A prospective single-blinded controlled study comparing laparoscopic ultrasound of the common bile duct with operative cholangiography
S. Tranter (2002)
Role of intraoperative cholangiography in avoiding bile duct injury.
Nader N. Massarweh (2007)
The Role of Cost-effectiveness Analysis in Health and Medicine
L. Russell (1996)
How the Patient-Centered Outcomes Research Institute can best influence real-world health care decision making.
A. Garber (2011)
Postoperative ERCP Versus Laparoscopic Choledochotomy for Clearance of Selected Bile Duct Calculi: A Randomized Trial
L. Nathanson (2005)
Intraoperative cholangiography in combination with laparoscopic ultrasonography for the detection of occult choledocholithiasis.
J. Li (2009)
Operative cholangiography: is there a statistical alternative?
T. Taylor (1983)
Meta-analysis of prevalence
J. Barendregt (2013)
Adverse outcomes of ERCP.
M. Freeman (2002)
The PCORI perspective on patient-centered outcomes research.
L. Frank (2014)
The Patient-Centered Outcomes Research Institute (PCORI) national priorities for research and initial research agenda.
Joe V. Selby (2012)
Hospital cost categories of one-stage versus two-stage management of common bile duct stones
B. Topal (2009)
Optimizing choledocholithiasis management: a cost-effectiveness analysis.
B. Poulose (2007)
A framework for assessing the value of diagnostic imaging in the era of comparative effectiveness research.
G. S. Gazelle (2011)
Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study.
S. Loperfido (1998)
Recommendations for reporting cost-effectiveness analyses. Panel on Cost-Effectiveness in Health and Medicine.
J. Siegel (1996)
Bile duct cannulation: success rates for various ERCP techniques and devices at a single institution.
J. García-Cano (2006)
A comparison of intraoperative ultrasound versus cholangiography in the evaluation of the common bile duct during laparoscopic cholecystectomy
J. Barteau (2004)
META‐ANALYSIS, DECISION ANALYSIS AND COST‐EFFECTIVENESS ANALYSIS: METHODS FOR QUANTITATIVE SYNTHESIS IN MEDICINE.
J. Deeks (1996)
Predictive Ability of Choledocholithiasis Indicators: A Prospective Evaluation
M. Hauer-Jensen (1985)
Laparoscopic Ultrasound for the Diagnosis of Choledocholithiasis: Quick, Safe, and Effective
H. Shaaban (2014)
Routine laparoscopic ultrasound can significantly reduce the need for selective intraoperative cholangiography during cholecystectomy
J. Machi (2007)
This paper is referenced by
Laparoscopic Biliary Ultrasound
Steven P. Bowers (2020)
ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis.
J. Buxbaum (2019)
Laparoscopic Ultrasonography Versus Magnetic Resonance Cholangiopancreatography in Laparoscopic Surgery for Symptomatic Cholelithiasis and Suspected Common Bile Duct Stones
Y. Luo (2018)
Laparoscopic ultrasonography as an alternative to intraoperative cholangiography during laparoscopic cholecystectomy
A. Dili (2017)
Intraoperative cholangiography with filling defects: comparative complication analysis of postoperative transcystic duct (TCD) catheter maintenance
Thiago B de Araujo (2020)
Protocol for laparoscopic cholecystectomy: Is it rocket science?
T. Hori (2016)
Intraoperative Ultrasound During Laparoscopic Cholecystectomy: An Alternative to Cholangiography
J. M. Jorge (2018)