Cost-effective management of common bile duct stones - A decision analysis of the use of endoscopic retrograde cholangiopancreatography (ERCP), intraoperative cholangiography, and laparoscopic bile duct exploration

被引:105
|
作者
Urbach, DR [1 ]
Khajanchee, YS [1 ]
Jobe, BA [1 ]
Standage, BA [1 ]
Hansen, PD [1 ]
Swanstrom, LL [1 ]
机构
[1] Legacy Hlth Syst, Dept Minimally Invas Surg & Surg Res, Portland, OR 97227 USA
来源
SURGICAL ENDOSCOPY-ULTRASOUND AND INTERVENTIONAL TECHNIQUES | 2001年 / 15卷 / 01期
关键词
decision analysis; cost-effectiveness; choledocholithiasis; common bile duct exploration; endoscopic retrograde cholangiopancreatography operative cholangiography;
D O I
10.1007/s004640000322
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: There are a variety of approaches to the diagnosis and treatment of common bile duct (CBD) stones in patients undergoing laparoscopic cholecystectomy (LC). Methods: Decision modeling was used to evaluate the cost effectiveness of four strategies for managing CBD stones around the time of LC: (a) routine preoperative endoscopic retrograde cholangiopancreatography (ERCP) (preoperative ERCP), (b) LC with intraoperative cholangiography (IOC), followed by laparoscopic common bile duct exploration (LCDE), (c) LC with IOC, followed by ERCP (postoperative ERCP), and (d) expectant management (LC without any tests for CBD stones). Local hospital data were used to estimate costs. Cost-effectiveness was expressed in terms of the cost per case of residual CBD stones prevented (in excess of the cost of LC alone). Diagnostic test characteristics, procedure success rates, and adverse event probabilities were derived from a systematic review of the literature. Sensitivity analysis was used to explore the effect of uncertainty on the results of the model. Results: LC alone was the least costly strategy, but it was also the least effective. Of the more aggressive strategies, LCDE and preoperative ERCP were associated with marginal costs of $5993.60 and $299,259.35, respectively, per case of residual CBD stones prevented. Postoperative ERCP was more costly and less effective than LCDE, but it had a lower cost-effectiveness ratio than preoperative ERCP when the prevalence of CBD stones was < 80%. Conclusions: Compared to other common approaches, laparoscopic CBD exploration is a cost-effective method of managing CBD stones in patients who undergo LC. If expertise in LCDE is unavailable, selective postoperative ERCP is preferred over routine preoperative ERCP, unless the probability of CBD stones is very high (> 80%).
引用
收藏
页码:4 / 13
页数:10
相关论文
共 50 条
  • [31] Management of Choledocholithiasis in a Community Hospital: Laparoscopic Common Bile Duct Exploration Versus Endoscopic Retrograde Cholangiopancreatography
    McNamee, Molly M.
    Stolz, Michael P.
    Harvell, Robert Tyler
    Staley, Christopher A.
    Green, Emilie E.
    Othman, Hedaya D.
    Gibson, Brian H.
    AMERICAN SURGEON, 2024, 90 (08) : 2011 - 2013
  • [32] Management of suspected common bile duct stones in children: Role of selective intraoperative cholangiogram and endoscopic retrograde cholangiopancreatography
    Mah, D
    Wales, P
    Njere, I
    Kortan, P
    Masiakos, P
    Kim, PCW
    JOURNAL OF PEDIATRIC SURGERY, 2004, 39 (06) : 808 - 812
  • [33] Low conjunction of the cystic duct into the common bile duct: Correlation of MR cholangiography (MRC) and endoscopic retrograde cholangiopancreatography (ERCP) findings
    Germanidis, G
    Tsitouridis, L
    Lazaraki, G
    Papastergiou, C
    Trigonis, K
    Pagkalos, E
    GASTROENTEROLOGY, 2005, 128 (04) : A765 - A765
  • [34] ULTRASOUND VS ENDOSCOPIC RETROGRADE CHOLANGIOGRAPHY IN COMMON BILE-DUCT STONES
    LESMANA, L
    PANG, RTL
    WIBOWO, S
    TJOKROSETIO, N
    NURMAN, A
    NOER, HMS
    DIGESTIVE DISEASES AND SCIENCES, 1986, 31 (10) : S121 - S121
  • [35] Current management of common bile duct stones: Is there a role for laparoscopic cholecystectomy and intraoperative endoscopic retrograde cholangiopancreatography as a single-stage procedure?
    Wright, BE
    Freeman, ML
    Cumming, JK
    Quickel, RR
    Mandal, AK
    SURGERY, 2002, 132 (04) : 729 - 735
  • [36] ERCP vs Laparoscopic Common Bile Duct Exploration for Common Bile Duct Stones: Are the 2 Techniques Truly Equivalent?
    Yachimski, Patrick
    Poulose, Benjamin K.
    ARCHIVES OF SURGERY, 2010, 145 (08) : 795 - 795
  • [37] ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN THE DIAGNOSIS AND TREATMENT OF COMMON BILE-DUCT STONES
    GALIANA, HG
    TAULLARD, D
    MARRUGO, A
    KUSTER, E
    PRENSA MEDICA ARGENTINA, 1990, 77 (01): : 1 - 8
  • [38] Treatment of common bile duct stones following failed endoscopic retrograde cholangiopancreatography
    Geldigitti, Ismail T.
    Karahan, Servet R.
    Adas, Gokhan
    Koc, Bora
    Gurbuz, Emin
    Ozsoy, Ayhan
    CHIRURGIA-ITALY, 2021, 34 (02): : 72 - 78
  • [39] USE OF ENDOSCOPIC RETROGRADE SPHINCTEROTOMY IN THE MANAGEMENT OF COMMON BILE-DUCT STONES
    DANILEWITZ, MD
    SOUTH AFRICAN MEDICAL JOURNAL, 1984, 65 (25): : 1018 - 1018
  • [40] Evaluation of the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) for common bile duct stones performed the same day as laparoscopic cholecystectomy
    LihBrody, L
    Kwak, GS
    Ward, R
    McKinley, M
    GASTROENTEROLOGY, 1996, 110 (04) : A466 - A466