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Magnetic resonance imaging in the diagnosis of choledocholithiasis

Gallstone disease is associated with an 8–20% incidence of the stones migrating into the common bile duct (CBD). In up to 5% of patients with gallstones, routine cholangiography at the time of cholecystectomy is the first time choledocholithiasis is detected. 1,2 While in many instances, CBD stones are asymptomatic, it is the development of the associated complications of cholangitis and pancreatitis that results in major morbidity and mortality. Hence it is critical that in the clinical management of CBD stones these stones be detected and treated appropriately before the development of cholangitis or pancreatitis. Until recently, endoscopic retrograde cholangiopancreatography (ERCP) has been the gold standard for the diagnosis of choledocholithiasis. While ERCP provides a highly accurate cholangiography for the detection of CBD stones, the procedure is invasive and associated with a reported complication rate ranging from 5.1% to 9.8%. It is not an easy procedure to perform as it requires instrumentation of the orifice of the bile and pancreatic duct. It is a procedure that is performed under sedation or general anaesthesia that needs administration and supervision by the anaesthetist. During the procedure, oxygen saturation and blood pressure require monitoring. Postprocedure, patients often need monitoring in a recovery or postoperative environment and are reviewed before discharge. 3