The Integration of Laboratory and Radiology Data: A Holistic Approach to Patient Diagnostics
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- Category: Vol. 84, December 2016
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The Integration of Laboratory and Radiology Data: A Holistic Approach to Patient Diagnostics
Abstract
Background: Biliary lithiasis is a common disorder af-fecting approximately 20% of the global population, with up to 20% of gallbladder stone cases associated with common bile duct stones (CBDS). Notably, up to 50% of CBDS cases may be asymptomatic. Despite the availability of various di-agnostic and therapeutic options, two main challenges persist: the cost-effective identification of CBDS and the appropriate management of diagnosed cases. Over the past three decades, advancements in imaging techniques, such as endoscopic ul-trasonography (EUS) and magnetic resonance cholangiography (MRC), alongside improvements in endoscopy and laparos-copy, have transformed the diagnosis and treatment of CBDS. Aim of Work: The aim of this study is to evaluate the risk of harboring CBDS and to compare different management strategies for patients diagnosed with CBDS, focusing on the effectiveness, invasiveness, and cost-effectiveness of various diagnostic and therapeutic approaches. Methods: The determination of the risk of carrying CBDS is based on an assessment of symptoms, liver and pancreas se-rology, and ultrasound imaging. Patients identified as “low risk” can proceed directly to laparoscopic cholecystectomy without further evaluation. For patients with an intermediate to high risk of CBDS, two primary approaches are considered: The lap-aroscopy-first approach, which utilizes intraoperative cholan-giography and laparoscopic common bile duct exploration, and the endoscopy-first approach, which employs diagnostic meth-ods such as MRC, EUS, and/or endoscopic retrograde cholan-giography (ERC), followed by endoscopic sphincterotomy.Results: The results indicate that intraoperative cholangio-graphy, EUS, and MRC provide comparable diagnostic out-comes for CBDS. Recent data suggest that surgical interven-tions yield better short- and long-term outcomes regarding the retention of stones and the necessity for additional treatments. While open surgery is more invasive, laparoscopic clearing of the common bile duct is technically demanding and time-con-suming, often requiring specialized equipment Conclusion: Despite ongoing debates and variations in practice influenced by equipment availability, staff expertise, and other factors, endoscopic therapy remains the preferred global approach for managing CBDS. The study underscores the importance of accurately assessing the risk of CBDS to guide management strategies effectively.