Discrepancies between cholecystography and ultrasonography in the detection of recurrent gallstones

• Published in: Journal of hepatology Vol. 1; no. 6; pp. 597 - 607
• Main Authors: Gleeson, D., Ruppin, D.C.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier B.V 1985; Elsevier
• Subjects: Biological and medical sciences; Cholecystography; Cholelithiasis - diagnosis; Cholelithiasis - diagnostic imaging; Diagnostic Errors; Evaluation Studies as Topic; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Medical sciences; Other diseases. Semiology; Recurrence; Ultrasonography - methods; Cholecystography; Human; Biliary tract; Radiodiagnosis; Ultrasonic investigation; Echography; Lithiasis; Digestive diseases; Diagnostic; Recurrent; Hepatobiliary disease; Comparative study
• ISSN: 0168-8278; 1600-0641
• DOI: 10.1016/S0168-8278(85)80003-9

As part of the British Gallstone Study Group's multi-centre post-dissolution trial of different treatment regimes designed to prevent recurrence after complete gallstone dissolution, the frequency of concordance and discordance between oral cholecystography (OCG) and ultrasonography (U/S), and between repeat U/S studies, in diagnosing recurrent stones was recorded. Before entering the trial, all patients had had complete gallstone dissolution, confirmed by 2 normal OCGs 3 months apart during continued bile acid treatment; and all but three had also had at least 1 normal U/S examination of the gallbladder. During 6–24 months follow-up, from a total of 129 U/S examinations, gallstone recurrence was detected on 25 occasions (19 definite and 6 probable) in 14 patients, and from a total of 71 OCGs, recurrent stones were detected on 11 occasions in 10 patients. All the presumed recurrences developed in the absence of symptoms. On 67 occasions, the OCG and U/S studies were performed within 8 weeks of each other and of these, there was discordance in 15 (22%). On 11 occasions (6 patients), ultrasound suggested recurrent stones despite a normal OCG whilst on 4 occasions (4 patients) stones diagnosed on OCG were not confirmed by ultrasound. Of the 25 instances of U/S recurrence, a further U/S examination was performed on 17 occasions in 11 patients which failed to confirm the initial findings on 8 occasions (7 patients). After 1 year's follow-up, the predicted recurrence rates (pooled data from all 3 treatment groups), as calculated by life table analysis, were 29.3 ± 7.1%, when the diagnosis was based on 1 U/S; 15.4 ± 5.8% on 1 OCG; 14.9 ± 5.6% on 2 successive U/S studies, and 8.1 ± 4.5% on 1 U/S plus 1 OCG. At 24 months, the corresponding values were 37.2 ± 8.3, 31.5 ± 8.6, 18.3 ± 6.3, and 22.4 ± 8.6%. These results show that following complete gallstone dissolution by bile acid treatment, there is both intra- and inter-technique variation in the detection of recurrent stones.