Abstract
Background
This is the first randomized trial to evaluate the efficacy of intraoperative cholangiography
(IOC) and magnetic resonance cholangiopancreatography (MRCP) in patients with suspected
CBDS.
Methods
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.
Results
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.
Conclusion
There is equipoise between both pathways. IOC has a significantly higher diagnostic
yield than MRCP.
Trial registration
Clinicaltrials.gov identifier NCT02351492: Radiological Investigation of Bile Duct
Obstruction (RIBO).
Graphical abstract
Graphical Abstract
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Article info
Publication history
Published online: June 17, 2022
Accepted:
May 31,
2022
Received:
January 12,
2022
Identification
Copyright
© 2022 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.
