Radiological Investigation of Bile Duct Obstruction
Radiological Investigation of Bile Duct Obstruction
Patients with gallstone disease should be checked whether a common bile duct (CBD) stone
 could be present. In case of a certain suspicion for CBD stones further investigations should
 be performed. This can either be done by magnetic resonance cholangio-pancreaticography
 (MRCP) or by intraoperative cholangiography. The study investigates which pathway would be
 favorable in regard of an early hospital demission.
Patients with gallstone disease and suspected bile duct obstruction can be investigated
 either with a magnetic resonance cholangio-pancreaticography (MRCP) prior to gallbladder
 removal or with an intraoperative cholangiography during cholecystectomy. When detecting an
 common bile duct (CBD) stone in MRCP, normally endoscopic removal is performed before an
 operation. When the CBD stone is detected during gallbladder removal instead, endoscopic
 retrograde cannulation of the pancreatic duct (ERCP) will follow after the operation.
 Investigators hypothesize that direct operation shortens the length of hospital stay.
 Therefore investigators randomize patients with elevated Bilirubin, elevated liver enzymes
 (two of the following: aspartate transaminase (ASAT), alanine aminotransferase (ALAT),
 gamma-glutamyltransferase (gGT) or AP), suspected CBD stones in ultrasound or dilated common
 bile ducts either in MRCP first or operation first pathway. All data (patient admission to
 discharge, ...) will be entered in an online database
Inclusion Criteria:

 -  Patients presenting as regular admission or at the emergency department (ED) with
 cholecystolithiasis and suspected CBD stones. The indication for CBD investigation
 requires one of the following features:

 i. Elevated bilirubin ii. ASAT/ALAT or gGT or aP above the normal range (two of them)
 iii. Choledocholithiasis in ultrasound iv. Dilated bile ducts in ultrasound

 -  Written informed consent

 Exclusion Criteria:

 -  Age under 18 years

 -  Patients with biliary pancreatitis (due to the fact that conservative treatment is
 initiated before gallbladder removal and therefore leads to a prolonged hospital stay)

 -  Septic patients due to cholangitis

 -  Patients unable to consent

 -  Patients with medical conditions preventing surgery

 -  Pregnancy

 -  Radiologically proven CBD stone