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Noninvasive Detection of Gallstone Acute Pancreatitis

Noninvasive Detection of Gallstone Acute Pancreatitis Abstract To the Editor.—We read with interest the article by Dr Neoptolemos and colleagues1 concerning the use of endoscopic retrograde cholangiopancreatography in the diagnosis and treatment of gallstone acute pancreatitis. The authors state that noninvasive imaging modalities, including ultrasonography and computed tomography, are of "dubious" value for detecting choledocholithiasis. We have found these modalities, especially computed tomography, to be quite useful in this regard. By using state-of-the-art equipment, fast scanners (≤2 s), and fine collimation (5 mm) scans, intraductal stones can be detected in up to 90% of cases.2,3 Improved ultrasound techniques, including scanning the intrapancreatic bile duct transversely with the patient upright, can increase the rate of sonographic detection to 89% and 70% for proximal and distal stones, respectively.4 The noninvasive imaging modalities can provide a fairly accurate screen for choledocholithiasis and should be considered before more invasive studies are undertaken. References 1. Neoptolemos JP, London N, Slater ND, et al: A prospective study of ERCP and endoscopic sphincterectomy in the diagnosis and treatment of gallstone acute pancreatitis: A rational and safe approach to management . Arch Surg 1986;121:697-702.Crossref 2. Jeffrey RB, Federle MP, Lang FC, et al: Computed tomography of choledocholithiasis . AJR 1983;140:1179-1183.Crossref 3. Mitchell SE, Clark RA: A comparison of computed tomography and sonography in choledocholithiasis . AJR 1984;142:729-733.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Noninvasive Detection of Gallstone Acute Pancreatitis

Archives of Surgery , Volume 122 (5) – May 1, 1987

Noninvasive Detection of Gallstone Acute Pancreatitis

Abstract

Abstract To the Editor.—We read with interest the article by Dr Neoptolemos and colleagues1 concerning the use of endoscopic retrograde cholangiopancreatography in the diagnosis and treatment of gallstone acute pancreatitis. The authors state that noninvasive imaging modalities, including ultrasonography and computed tomography, are of "dubious" value for detecting choledocholithiasis. We have found these modalities, especially computed tomography, to be quite useful in this...
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Publisher
American Medical Association
Copyright
Copyright © 1987 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1987.01400170126022
Publisher site
See Article on Publisher Site

Abstract

Abstract To the Editor.—We read with interest the article by Dr Neoptolemos and colleagues1 concerning the use of endoscopic retrograde cholangiopancreatography in the diagnosis and treatment of gallstone acute pancreatitis. The authors state that noninvasive imaging modalities, including ultrasonography and computed tomography, are of "dubious" value for detecting choledocholithiasis. We have found these modalities, especially computed tomography, to be quite useful in this regard. By using state-of-the-art equipment, fast scanners (≤2 s), and fine collimation (5 mm) scans, intraductal stones can be detected in up to 90% of cases.2,3 Improved ultrasound techniques, including scanning the intrapancreatic bile duct transversely with the patient upright, can increase the rate of sonographic detection to 89% and 70% for proximal and distal stones, respectively.4 The noninvasive imaging modalities can provide a fairly accurate screen for choledocholithiasis and should be considered before more invasive studies are undertaken. References 1. Neoptolemos JP, London N, Slater ND, et al: A prospective study of ERCP and endoscopic sphincterectomy in the diagnosis and treatment of gallstone acute pancreatitis: A rational and safe approach to management . Arch Surg 1986;121:697-702.Crossref 2. Jeffrey RB, Federle MP, Lang FC, et al: Computed tomography of choledocholithiasis . AJR 1983;140:1179-1183.Crossref 3. Mitchell SE, Clark RA: A comparison of computed tomography and sonography in choledocholithiasis . AJR 1984;142:729-733.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: May 1, 1987

References