The role of intravenous cholangiography in the era of laparoscopic cholecystectomy: is there a renaissance?

Background and objective: The preoperative investigation for choledocholith iasis in patients undergoing elective laparoscopic cholecystectomy is still a matter of debate. Patients and methods: In a prospective clinical trial the accuracy of intra venous cholangiography (IVC), ultrasonography and liver function tests in t he preoperative diagnosis of choledocholithiasis was assessed in 98 patient s undergoing elective cholecystectomy. Only patients with uncomplicated cho lecystolithiasis considered to be at low risk for having bile duct stones w ere investigated. A 2-year follow-up clinical survey (mean) was performed i n 92 of the 98 patients to investigate the occurrence of postoperative chol edocholithiasis (gold standard: clinically manifest choledocholithiasis). Results: In this patient cohort the incidence of choledocholithiasis was fo und to be 5.1%. Among the three diagnostic tests IVC proved tol be more acc urate with higher sensitivity and a better positive predictive value than u ltrasonography and liver function tests. The sensitivity for IVC was 100% c ompared to 20% for ultrasonography and 40% for liver function tests, respec tively. The positive predictive value for IVC was 83.3% in comparison to 20 % for ultrasonography and 25% for liver function tests. Mild side effects c aused by intravenous contrast media were observed in 2.0%. During a mean po stoperative follow-up of 2 years no clinically manifest and initially overl ooked choledocholithiasis could be detected in the 92 investigated patients . Conclusion: IVC is a reliable method to detect unsuspected common bile duct stones and should be used in the preoperative diagnosis prior to elective laparoscopic cholecystectomy. IVC may play a role in decreasing the rate of preoperative ERCP or intraoperative cholangiography in these patients.