Gallstones top to toe: what the radiologist needs to know
AbstractGallstone-related disease can have significant associated morbidity and mortality worldwide. The incidence of gallstone-related disease in the Western world is on the increase. There are multiple different pathological manifestations of gallstone disease: the presentation, diagnosis and associated complications of which vary significantly depending on anatomical location. The role of imaging in gallstone-related disease is broad with radiology playing an essential role in the diagnosis, management and follow-up of gallstone-related pathologies. This paper distills the broad range of gallstone-related pathologies into an anatomical map, discussing the disease processes involved at each point along the biliary tree and reviewing the strengths and weaknesses of different imaging modalities for each distinct disease process.
Conclusions: Diagnosis of XGC and differentiation from gallbladder carcinoma may be difficult through preoperative or peroperative studies, even imaging is useful; the definitive diagnosis depends exclusively on pathologic examination. The surgeon should be prepared for every possibility.
Cirrhotic patients have higher hazard of pancreatobiliary events due to increased risk of gallstones formation and the cholestasis in this population. Endoscopic retrograde cholangiopancreatograpy (ERCP) is one of the main treatments for extrahepatic biliary diseases. Current guidelines stress the careful selection of patients undergoing ERCP. Although ERCP has been widely performed in cirrhotic patients, the published data evaluating post ERCP adverse events (AEs) in these patients are limited.
Choledocholithiasis (CDL) develops in up to 20% of individuals with symptomatic gallstones and is a major source of morbidity. Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard procedure for the diagnosis and treatment of CDL but it carries a 5-15% risk of adverse events. Therefore, identifying patients likely to have bile duct stones is important prior to proceeding with ERCP. In 2010 the American Society for Gastrointestinal Endoscopy (ASGE) put forth guidelines to help risk stratify patients with suspected CDL most likely to benefit from ERCP, which were revised in 2019.
Cholestatic jaundice affects up to 1 in 2500 newborns. Possible causes include bacterial sepsis, galactosemia, tyrosinemia, panhypo-pituitarism, bile acid synthetic defects, obstructive gallstones and Biliary atresia (BA). BA is a destructive cholangiopathy of neonates, which can lead to portal hypertension and liver failure if not identified early and a Kasai hepatoportoenterostomy performed timely to restore bile flow. Diagnostic algorithms vary substantially between different centres, with some units advocating ERCP be performed in every case.
The advantages of the treatment of choledocholithiasis and cholelithiasis in a single surgical time have been well established, but the types of access used and their combinations, the assistance processes and the assessment of cost effectiveness are still being studied.
Pregnancy is associated with an increased risk of gallstone formation and related complications.Some of these complications need use of endoscopic retrograde cholangiopancreatography (ERCP). ERCP could become technically challenging in pregnant patients.Our aim is to study trends and outcomes of ERCP among pregnant patients from nationwide analysis.
Gallstone diseases have a high prevalence in western populations and pose a large burden to health care systems. While endoscopic retrograde cholangiopancreatography (ERCP) is the primary treatment of choice for common bile duct stones (CBDS), post-ERCP cholecystectomy (CCY) is often performed to prevent recurrent gallstone disease. The effect of post-ERCP CCY compared to primary ERCP alone on the rate of recurrent CBDS has not been described in a general population over a prolonged period of time.
Acute pancreatitis is a very common cause of hospital admission and is associated with significant morbidity and mortality. Gallstones account for 30-50 percent of all acute pancreatitis presentations. Per guidelines, Endoscopic Retrograde Cholangiopancreatogram (ERCP) is frequently performed in these patients without cholangitis within 72 hours but evidence regarding optimal timing is not concrete. We aimed to perform an analysis to see if ERCP within 24 hours of admission affects outcomes in patients admitted with acute biliary pancreatitis.
A 36-year-old man with a past medical history significant for antiphospholipid syndrome complicated by a cerebrovascular event requiring indefinite coumadin anticoagulation, presented for epigastric pain and vomiting of a few days duration. His blood work was unremarkable except for an elevated lipase (150) without meeting the acute pancreatitis criteria. An ultrasound of the abdomen was negative for cholelithiasis and unremarkable bile ducts. However, a CT showed edema around the portal confluence.