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EUS Prior to ERCP in the Positive Setting of Positive Intraoperative Cholangiogram (IOC) During Cholecystectomy

This study has been completed.
Information provided by (Responsible Party):
Jonh Evans, Wake Forest University Health Sciences Identifier:
First received: January 30, 2012
Last updated: April 17, 2017
Last verified: April 2017
Performing an EUS prior to ERCP in the setting of a positive intraoperative cholangiogram will identify and risk stratify patients for the presence of CBD stones and strictures.

Calculi Stenosis of Bile Duct

Study Type: Observational
Study Design: Observational Model: Cohort
Time Perspective: Prospective
Official Title: A Prospective Study Evaluation the Role of EUS Prior to ERCP in the "Positive" Setting of Positive Intraoperative Cholangiogram (IOC) During Cholecystectomy

Further study details as provided by Jonh Evans, Wake Forest University Health Sciences:

Primary Outcome Measures:
  • Bile Duct [ Time Frame: 2 years ]
    Stone seen by EUS confirmed by ERCP

Secondary Outcome Measures:
  • Lesions [ Time Frame: 2 Years ]
    Presence of obstuctinn lesion seen by EUS

  • Bile duct [ Time Frame: 2 years ]
    Diameter of common bile duct and common hepatic duct

  • Diverticulum [ Time Frame: 2 years ]
    Presence of periampullary diverticulum seen by endoscopy

  • ERCP [ Time Frame: 2 years ]
    Number of ERCP's that could have been avoided

  • ERCP [ Time Frame: 2 years ]
    Complications from ERCP

Enrollment: 34
Actual Study Start Date: October 2010
Study Completion Date: June 7, 2016
Primary Completion Date: June 7, 2016 (Final data collection date for primary outcome measure)
EUS prior to ERCP

Detailed Description:

During routine cholecystectomy, surgeons will often perform an intraoperative cholangiogram in an effort to define anatomical landmarks and ensure patency and drainage of the common bile duct. This involves injecting a radiopaque contrast medium into the biliary tree during the operation. Occasionally contrast injection onto the common bile duct will reveal an abnormality and are deemed a "positive intraoperative cholangiogram" (positive IOC). These abnormalities can include the following: single or multiple stones; non-filling of the duodenum by contrast; stenosis or narrowing of the common bile duct (CBD). When discovered these findings are better addressed and treated endoscopically via endoscopic retrograde cholangiopancreatography (ERCP). ERCP's are considered the gold standard for the diagnosis and treatment of positive intraoperative cholangiograms. However, several studies have shown that 40-50% of patients who undergo an ERCP after a "positive" IOC have a normal cholangiogram. Reasons for this include spontaneous stone passage of the stone, dysmotility of the biliary tree, or poor quality, incomplete, or misinterpretation of the IOC. Therefore ERCP's are being performed when they could be avoided. ERCP performance carries significant complications including pancreatitis (5-10%), bleeding, and perforation. Ideally if a safer test to assess the bile duct could be performed immediately prior to the ERCP to confirm the presence of the positive IOC findings, this would ensure that the ERCP is being performed for therapeutic means thus avoiding unnecessary ERCP's.

EUS is often performed prior to ERCP's under the same sedation in our endoscopy unit. From 2005 to 2007, two hundred and twenty seven "combined EUS and ERCP procedure were performed.(unpublished internal data). Our experience with "combined" EUS and ERCP procedures has demonstrated that performing an EUS prior to an ERCP will prolong the total procedure time less than 10 minutes with no significant increase in adverse events. Performance of an EUS prior to ERCP to confirm biliary pathology after a "positive" IOC has never been studied in a rigorous fashion.


Ages Eligible for Study:   18 Years to 85 Years   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Sampling Method:   Non-Probability Sample
Study Population
Patients who have gone an uncomplicated cholesytectomy and determined to have a "positive intraoperative cholangiogram" within one month of presentation to Wake Forest Baptist Health.

Inclusion Criteria:

  • Subjects must be able to review and sign informed consent
  • Cholecystectomy must have been performed within one month of enrollment
  • Positive intraoperative cholangiogram
  • Stone
  • Multiple Stones
  • Stenosis
  • "non filling" of duodenum
  • Dilated bile duct

Exclusion Criteria:

  • Cannot give and sign informed consent
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT01525355

United States, North Carolina
Wake Forest Baptist Health
Winston Salem, North Carolina, United States, 27157
Sponsors and Collaborators
Wake Forest University Health Sciences
Principal Investigator: John A Evans, MD Wake Forest University Baptist Health
  More Information

Responsible Party: Jonh Evans, Principal Investigator, Wake Forest University Health Sciences Identifier: NCT01525355     History of Changes
Other Study ID Numbers: IRB00013737
Study First Received: January 30, 2012
Last Updated: April 17, 2017

Keywords provided by Jonh Evans, Wake Forest University Health Sciences:
Intraoperative cholangiogram
Common Bile Duct Stones
Dilated Bile duct
Non-filling of the duodenum by contrast

Additional relevant MeSH terms:
Pathological Conditions, Anatomical processed this record on September 20, 2017