Can three-dimensional helical GT cholangiography before laparoscopic cholecystectomy be a substitute study for endoscopic retrograde cholangiography?

The study investigated the usefulness of three-dimensional helical computed tomography (3D-CT) before laparoscopic cholecystectomy (LSC) when compared with that of endoscopic retrograde cholangiography (ERC). Forty-five patie nts referred for LSC, who had undergone 3D-CT cholangiography and ERC simul taneously, participated in the study. Endoscopic retrograde cholangiography and 3D-CT cholangiography were compared in each patient with regard to opa cification of the biliary tree, stones, and anatomic variations. Three-dime nsional helical CT cholangiography and ERC imaging fbr predicting operative difficulties in LSC also were compared. The common bile duct and cystic du ct were shown in the patients by the images, but the gallbladder was shown in 43 patients 66%) with use of 3D-CT cholangiography and in 36 patients (8 0%) with use of ERC. A third or more peripheral branches were shown complet ely with use of 3D-CT cholangiography in 33 patients (73%) and in 32 patien ts (71%) with use of ERC. Cystic duct stones were found in two of three pat ients with use of 3D-CT cholangiography and ERC. Common bile duct stones in five of seven patients were detected with use of 3D-CT cholangiography, bu t all of the common bile duct stones were detected with use of ERC. Anatomi c variations of the bile duct were shown in three of four patients by 3D-CT cholangiography and in all patients with use of ERC. No significant differ ences in findings of the angle of bifurcation and presence of Heister valve s between operative easy and complex cases were shown by 3D-CT cholangiogra phy and ERC, despite the more accurate assessment of the cystic duct anatom y with use of 3D-CT cholangiography than with use of ERC. Three-dimensional helical CT cholangiography is useful clinically in preoperative assessment of biliary anatomy, but it is not reliable in the detection of common bile duct stones, and it is not helpful in predicting technical difficulty duri ng LSC.