Brian R Davidson

University College London, Londinium, England, United Kingdom

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Publications (416)2048.42 Total impact

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    ABSTRACT: Objective: This study sought to compare the perioperative outcomes of interventions aiming to decrease ischemia-reperfusion (IR) injury during elective liver resection. Method: A comprehensive literature search was performed to identify randomized controlled trials. A Bayesian network metaanalysis was performed using the Markov chain Monte Carlo method in WinBUGS following the guidelines of the National Institute for Health and Clinical Excellence Decision Support Unit. Odds ratios for binary outcomes and mean differences for continuous outcomes were calculated using a fixed effect model or a random effects model according to model fit. Results: Forty-four trials with 2,457 patients having undergone liver resection were included and were divided into 8 classes of interventions aimed at decreasing IR injury and a control group, which was hepatectomy alone. There was no difference between the different interventions in mortality, quantity of blood transfusion, and durations of stay in an intensive therapy unit between any pairwise comparisons. Patients treated with ischemic preconditioning, cardiovascular modulators, and miscellaneous interventions had significantly fewer serious adverse events compared with patients undergoing liver resection alone. Ischemic preconditioning patients had significantly fewer transfusion proportions and shorter operative time than patients treated with steroids. Ischemic preconditioning had significantly less operative blood loss compared with all other interventions, and a lesser duration of hospital stay than hepatectomy alone. Sensitivity analysis showed that the drugs sevoflurane (a volatile anesthetic), verapamil (a calcium channel blocker), and gabexate mesilate (a thrombin inhibitor) produced fewer serious adverse events compared with hepatectomy alone. Conclusion: Ischemic preconditioning resulted in multiple beneficial clinical endpoints and further RCTs seem to be needed to confirm its clinical benefits.
    Surgery 11/2015; DOI:10.1016/j.surg.2015.10.011 · 3.38 Impact Factor
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    ABSTRACT: Methods: A single centre prospectively collected liver transplant database was analysed for the period 1988-2012. All patients were followed up for 5 years or until graft failure. Transaminase levels on the 1(st) , 3(rd) and 7(th) post-operative days were correlated with the patient demographics, operative outcomes, post-operative complications and both graft and patient survival via a binary logistic regression analysis. Results: Graft and patient survival at 3 months was 80.3% and 87.5%. AST levels on the 3(rd) (p=0.005) and 7(th) (p=0.001) post-operative days correlated with early graft loss. Patients were grouped by their AST level (day 3): <107iU, 107-1213iU, 1213-2744iU and >2744iU. The incidence of graft loss at 3 months was 10%, 12%. 27% and 59% and 1 year patient mortality was 12%, 14%, 27% and 62%. Conclusions: Day 3 AST levels correlate with patient and graft outcome post liver transplantation and would be a suitable surrogate end-point for clinical trials in liver transplantation. This article is protected by copyright. All rights reserved.
    Transplant International 11/2015; DOI:10.1111/tri.12723 · 2.60 Impact Factor
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    ABSTRACT: Introduction: Intraoperative haemorrhage remains one of the major risks during liver resection, and perioperative blood loss and blood transfusion are important factors affecting perioperative morbidity and mortality. The aim of this study is to compare treatment strategies aiming to decrease blood loss during hepatectomy. Methods: A systematic review of the literature was performed to identify randomised controlled trials reporting on the method of vascular occlusion, parenchymal transection, and management of the cut surface during liver resection. A Bayesian network meta-analysis was performed using WinBUGS. Results: Seven trials reporting on 496 participants randomised to seven treatment strategies were analysed. Continuous vascular occlusion resulted in lower blood loss compared to no vascular occlusion when parenchymal transection was performed with clamp-crush and no fibrin sealant was used for the cut surface. People undergoing liver resection by continuous vascular occlusion had decreased amounts of blood transfused than people with intermittent vascular occlusion when parenchymal transection was performed with clamp-crush and no fibrin sealant. There was no significant difference in proportion of people transfused, mortality, or hospital stay between the different strategies. There were significantly more serious adverse events when surgery was performed using radiofrequency dissecting sealer compared with standard clamp-crush method in the absence of vascular occlusion and fibrin sealant. Conclusions: Continuous vascular occlusion during hepatectomy results in decreased blood loss and decreased blood transfusion requirements. Further studies are needed to compare treatment strategies aiming to decrease blood loss, defined by their method of vascular occlusion, parenchymal transection, and management of the cut surface.
    International Journal of Surgery (London, England) 10/2015; 23(Pt A). DOI:10.1016/j.ijsu.2015.09.064 · 1.53 Impact Factor
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    ABSTRACT: Indicators of operative outcomes could be used to identify underperforming surgeons for support and training. The feasibility of identifying HPB surgeons with poor operative performance (“outliers”) based on the results of pancreatic resections is not known. Methods. A systematic review of Medline, Embase, and the Cochrane library was performed to identify studies on pancreatic resection including at least 100 patients and published between 2004 and 2014. Proportions that lay outside the upper 95% and 99.8% confidence intervals based on results of the systematic reviews were considered as “outliers.” Results. In total, 30 studies reporting on 10712 patients were eligible for inclusion in this review. The average short-term mortality after pancreatic resections was 3.1% and proportion of patients with procedure-related complications was 47.0%. None of the classification systems assessed the long-term impact of the complications on patients. The surgeon-specific mortality should be 5 times the average mortality before he or she can be identified as an outlier with 0.1% false positive rate if he or she performs 50 surgeries a year. Conclusions. A valid risk prognostic model and a classification system of surgical complications are necessary before meaningful comparisons of the operative performance between pancreatic surgeons can be made.
    HPB Surgery 09/2015; 2015(4):896875. DOI:10.1155/2015/896875
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    4th European Congress of Immunology, Vienna, Austria; 09/2015
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    ABSTRACT: Liver synthetic and metabolic function can only be optimised by the growth of cells within a supportive liver matrix. This can be achieved by the utilisation of decellularised human liver tissue. Here we demonstrate complete decellularization of whole human liver and lobes to form an extracellular matrix scaffold with a preserved architecture. Decellularized human liver cubic scaffolds were repopulated for up to 21 days using human cell lines hepatic stellate cells (LX2), hepatocellular carcinoma (Sk-Hep-1) and hepatoblastoma (HepG2), with excellent viability, motility and proliferation and remodelling of the extracellular matrix. Biocompatibility was demonstrated by either omental or subcutaneous xenotransplantation of liver scaffold cubes (5 × 5 × 5 mm) into immune competent mice resulting in absent foreign body responses. We demonstrate decellularization of human liver and repopulation with derived human liver cells. This is a key advance in bioartificial liver development.
    Scientific Reports 08/2015; 5:13079. DOI:10.1038/srep13079 · 5.58 Impact Factor
  • F P Robertson · D Tsironis · B R Davidson ·
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    ABSTRACT: Diaphragmatic lesions are usually congenital bronchogenic cysts. A patient with a known diaphragmatic cyst presented with new onset right upper quadrant pain. Repeat imaging showed enlargement of the cyst, the CA19-9 cancer marker was raised at 312iu/ml (normal: <27iu/ml) and positron emission tomography combined with computed tomography showed focally increased uptake in the cystic wall. In view of symptoms and risk of neoplasia, the lesion was excised. Histology showed a benign epidermoid cyst. Features falsely suggesting neoplasia have been reported previously with benign splenic cysts but not with a benign diaphragmatic epidermoid cyst.
    Annals of The Royal College of Surgeons of England 07/2015; 97(5):e77-8. DOI:10.1308/003588415X14181254790329 · 1.27 Impact Factor
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    ABSTRACT: Laparoscopic liver resection has significant advantages over open surgery due to less patient trauma and faster recovery times, yet is difficult for most lesions due to the restricted field of view and lack of haptic feedback. Image guidance provides a potential solution but is challenging in a soft deforming organ such as the liver. In this paper, we therefore propose a laparoscopic ultrasound (LUS) image guidance system and study the feasibility of a locally rigid registration for laparoscopic liver surgery. We developed a real-time segmentation method to extract vessel centre points from calibrated, freehand, electromagnetically tracked, 2D LUS images. Using landmark-based initial registration and an optional iterative closest point (ICP) point-to-line registration, a vessel centre-line model extracted from preoperative computed tomography (CT) is registered to the ultrasound data during surgery. Using the locally rigid ICP method, the RMS residual error when registering to a phantom was 0.7 mm, and the mean target registration error (TRE) for two in vivo porcine studies was 3.58 and 2.99 mm, respectively. Using the locally rigid landmark-based registration method gave a mean TRE of 4.23 mm using vessel centre lines derived from CT scans taken with pneumoperitoneum and 6.57 mm without pneumoperitoneum. In this paper we propose a practical image-guided surgery system based on locally rigid registration of a CT-derived model to vascular structures located with LUS. In a physical phantom and during porcine laparoscopic liver resection, we demonstrate accuracy of target location commensurate with surgical requirements. We conclude that locally rigid registration could be sufficient for practically useful image guidance in the near future.
    International Journal of Computer Assisted Radiology and Surgery 06/2015; 10(12). DOI:10.1007/s11548-015-1236-8 · 1.71 Impact Factor
  • Rahul S Koti · Christopher J Davidson · Brian R Davidson ·
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    ABSTRACT: Acute cholecystitis occurs in approximately 1 % of patients with known gallstones. It presents as a surgical emergency and usually requires hospitalisation for treatment. It is associated with significant morbidity and mortality, particularly in the elderly. Cholecystectomy is advocated for acute cholecystitis; however, the timing of cholecystectomy and the value of the additional treatments have been a matter of debate. This review examines the available evidence regarding the optimal surgical management of patients with acute cholecystitis. A literature search was performed on the MEDLINE, EMBASE and WHO International Clinical Trials Registry Platform, databases for English language publications. The MeSH headings 'cholecystitis', 'acute', 'gallbladder', 'inflammation', 'surgery', 'cholecystectomy', 'laparoscopic', 'robotic', 'telerobotic' and 'computer-assisted' were used. Data from eight randomised controlled trails and three population-based analyses show that early cholecystectomy for acute cholecystitis performed on the index admission is safe and not associated with increased conversion rates or morbidity in comparison to conservative treatment followed by elective cholecystectomy. Delaying cholecystectomy increases readmissions for gallstone-related events, complications, hospital stay and mortality in the elderly. Early cholecystectomy is also more cost-effective. Randomised trials addressing antibiotic use in acute cholecystitis suggest that antibiotics should be stopped on the day of cholecystectomy. Insufficient trials have been performed to address the optimal analgesia regime post cholecystectomy. Similarly, a lack of trials on intraoperative cholangiography and management of common bile duct stones in patients with acute cholecystitis means that treatment of concomitant bile duct stones should be based on institutional expertise and resource availability. As regards acute cholecystitis in elderly and high-risk patients, case series and retrospective studies would suggest that cholecystectomy is more effective and of lower mortality than percutaneous cholecystostomy. There is not enough evidence to support the routine use of robotic surgery, single-incision laparoscopic cholecystectomy or natural orifice transluminal endoscopic surgery (NOTES) in the treatment of acute cholecystitis. Trial evidence would favour a policy of early laparoscopic cholecystectomy following admission with acute cholecystitis. The optimal approach to support early cholecystectomy is suggested but requires evidence from further randomised trials.
    Langenbeck s Archives of Surgery 05/2015; 400(4). DOI:10.1007/s00423-015-1306-y · 2.19 Impact Factor
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    ABSTRACT: Extract: Exome sequencing of sporadic pancreatic neuroendocrine tumours (PNETs) has identified mutually exclusive mutations in the chromatin regulators α- thalassaemia/mental retardation X-linked (ATRX) and death associated protein 6 (DAXX) genes in 43% of cases (18% and 23% of cases respectively in 68 cases studied) (Elsässer et al. 2011; Jiao et al. 2011). ATRX and DAXX are chromatin remodelers; their loss leads to alternative lengthening of telomeres (ALT) and chromosomal instability (CIN) (Heaphy et al. 2011). ALT is a telomerase independent mechanism for maintenance of telomere stabilisation. Although it was initially reported that ATRX/DAXX mutant tumours had superior 10-year survival and outcome (Jiao et al. 2011), a recent larger study on 243 tumours has demonstrated that ATRX and DAXX loss and associated ALT in PNETs correlates with CIN, advanced tumour stage, development of metastases and poorer progression free (PFS) and overall survival (OS) (Marinoni et al. 2014) ...
    Endocrine Related Cancer 04/2015; DOI:10.1530/ERC-15-0108 · 4.81 Impact Factor
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    ABSTRACT: Surgical resection is the only curative treatment for pancreatic and periampullary cancer, but many patients undergo unnecessary laparotomy because tumours can be understaged by computerised tomography (CT). A recent Cochrane review found diagnostic laparoscopy can decrease unnecessary laparotomy. We compared the cost-effectiveness of diagnostic laparoscopy prior to laparotomy versus direct laparotomy in patients with pancreatic and periampullary cancer with resectable disease based on CT scanning. Model based cost-utility analysis estimating mean costs and quality-adjusted life years (QALYs) per patient from the perspective of the UK National Health Service. A decision tree model was constructed using probabilities, outcomes and cost data from published sources. One-way and probabilistic sensitivity analyses were undertaken. When laparotomy following diagnostic laparoscopy occurred in a subsequent admission, diagnostic laparoscopy incurred similar mean costs per patient to direct laparotomy (£7470 versus £7480); diagnostic laparoscopy costs (£995) were offset by avoiding unnecessary laparotomy costs. Diagnostic laparoscopy produced significantly more mean QALYs per patient than direct laparotomy (0.346 versus 0.337). Results were sensitive to the accuracy of diagnostic laparoscopy and the probability that disease was unresectable. Diagnostic laparoscopy had 63 to 66% probability of being cost-effective at a maximum willingness to pay for a QALY of £20 000 to £30 000. When laparotomy was undertaken in the same admission as diagnostic laparoscopy the mean cost per patient of diagnostic laparoscopy increased to £8224. Diagnostic laparoscopy prior to laparotomy in patients with CT-resectable cancer appears to be cost-effective in pancreatic cancer (but not in periampullary cancer), when laparotomy following diagnostic laparoscopy occurs in a subsequent admission.
    BMC Gastroenterology 04/2015; 15(1). DOI:10.1186/s12876-015-0270-x · 2.37 Impact Factor
  • Soumil Vyas · Alicja Psica · Jennifer Watkins · Dominic Yu · Brian Davidson ·
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    ABSTRACT: Leiomyomas are benign lesions arising from the smooth muscle layer. They are most commonly detected either within the gastrointestinal or genitourinary tracts. Primary hepatic leiomyoma (PHL) is a rare pathology. It is an isolated pathology within the liver, without evidence of any other coexisting leiomyomas. Very few cases have been described in literature. PHL may occur in healthy individuals although an association with immunodeficiency and Epstein-Barr virus (EBV) infection has been observed. Majority of the reported cases have been in females. A 20-year-old female patient presented with abdominal symptoms. MRI confirmed an 8 cm mass, with very low signal intensity on T2 images and peripheral rim enhancement on gadolinium. A laparoscopic left lateral sectorectomy was performed. Final histopathology confirmed the presence of benign lesion with spindle cell and smooth muscle proliferation and a fibro-vascular stroma compatible with a leiomyoma. There was no evidence of any leiomyomatous lesion elsewhere in the body. A rare diagnosis of PHL was therefore established. Acknowledging the rare incidence of this lesion, we report the same and review the relevant literature. PHL is usually a retrospective diagnosis, confirmed on histo-pathology assessment of the resected specimen. Liver resection is required in these patients due to the presence of symptoms, in the presence of a solid mass lesion within the liver. Surgery is thus definitive, diagnostic cum therapeutic.
    04/2015; 3(5):73. DOI:10.3978/j.issn.2305-5839.2015.03.40

  • Cohrane Database of Systematic Reviews 04/2015; DOI:10.1002/14651858.CD011645

  • Cohrane Database of Systematic Reviews 04/2015; DOI:10.1002/14651858.CD011641

  • Cohrane Database of Systematic Reviews 04/2015; DOI:10.1002/14651858.CD011644

  • Cohrane Database of Systematic Reviews 04/2015; DOI:10.1002/14651858.CD011643
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    ABSTRACT: Probe-based confocal laser endomicroscopy is an emerging imaging modality that enables visualization of histologic details during endoscopy and surgery. A method of guiding the probe with millimeter accuracy is required to enable imaging in all regions of the abdomen accessed during laparoscopy. On the basis of a porcine model of laparoscopic liver resection, we report our experience of using a steerable intravascular catheter to guide a probe-based confocal laser endomicroscope.This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
    Surgical laparoscopy, endoscopy & percutaneous techniques 03/2015; 25(2). DOI:10.1097/SLE.0000000000000139 · 1.14 Impact Factor
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    ABSTRACT: Background: Patients with suspected common bile duct (CBD) stones are often diagnosed using endoscopic retrograde cholangiopancreatography (ERCP), an invasive procedure with risk of significant complications. Using endoscopic ultrasound (EUS) or Magnetic Resonance CholangioPancreatography (MRCP) first to detect CBD stones can reduce the risk of unnecessary procedures, cut complications and may save costs. Aim: This study sought to compare the cost-effectiveness of initial EUS or MRCP in patients with suspected CBD stones. Methods: This study is a model based cost-utility analysis estimating mean costs and quality-adjusted life years (QALYs) per patient from the perspective of the UK National Health Service (NHS) over a 1 year time horizon. A decision tree model was constructed and populated with probabilities, outcomes and cost data from published sources, including one-way and probabilistic sensitivity analyses. Results: Using MRCP to select patients for ERCP was less costly than using EUS to select patients or proceeding directly to ERCP ($1299 versus $1753 and $1781, respectively), with similar QALYs accruing to each option (0.998, 0.998 and 0.997 for EUS, MRCP and direct ERCP, respectively). Initial MRCP was the most cost-effective option with the highest monetary net benefit, and this result was not sensitive to model parameters. MRCP had a 61% probability of being cost-effective at $29,000, the maximum willingness to pay for a QALY commonly used in the UK. Conclusion: From the perspective of the UK NHS, MRCP was the most cost-effective test in the diagnosis of CBD stones.
    PLoS ONE 03/2015; 10(3):e0121699. DOI:10.1371/journal.pone.0121699 · 3.23 Impact Factor
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    ABSTRACT: Model for End Stage Liver Disease (MELD) is used to in America and Europe to aid the decision of listing a patient for liver transplantation. United Kingdom Model for End Stage Liver Disease (UKELD) is used in the UK to predict mortality in end stage liver disease and to aid the decision of listing a patient for liver transplantation. The role of MELD and UKELD in predicting mortality post successful orthotopic liver transplantation remains controversial. Recent studies have suggested that MELD has no role in this situation. Our aim was analyse UKELD and MELD score in predicting 1 year mortality following liver transplantation in one large UK transplant database. Methods: Data was reviewed for 1272 patients undergoing liver transplantation between 1988 and 2012. Clinical data collected was recipient age, gender, MELD and UKELD score, pre-operative haemoglobin, donor age, cold ischaemic time, secondary warm ischaemic time, type of graft (DCD, DBD, split, domino), graft appearance and one year mortality rates. A linear regression model was performed on SPSS. Results: 1272 patients 640M/628F/4 Unspecified were identified. 1218 had a 1 year mortality documented 311 of which had a UKELD score. All patients had a MELD score. 216 (17.7%) of patients died within 1 year. The mean MELD score was 18.43 (21.38 patients that died/17.74 in patients that survived) the mean UKELD score was 54.95 (55.6 in patients that died/54.93 in patients that survived). When corrected for all factors higher MELD scores predict increased risk or dying within one year of liver transplantation (p=0.014). UKELD had no predictive role in 1 year mortality (p=0.106). Conclusions: Higher pre-operative MELD scores are associated with increased mortality following liver transplantation in a UK population. The MELD score therefore is useful not only as a tool to aid decision for listing but to risk stratify patients pre-operatively.
    British Transplantation Society; 03/2015
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    ABSTRACT: Background: Endoscopic retrograde cholangiopancreatography (ERCP) and intraoperative cholangiography (IOC) are tests used in the diagnosis of common bile duct stones in people suspected of having common bile duct stones. There has been no systematic review of the diagnostic accuracy of ERCP and IOC. Objectives: To determine and compare the accuracy of ERCP and IOC for the diagnosis of common bile duct stones. Search methods: We searched MEDLINE, EMBASE, Science Citation Index Expanded, BIOSIS, and to September 2012. To identify additional studies, we searched the references of included studies and systematic reviews identified from various databases (Database of Abstracts of Reviews of Effects (DARE)), Health Technology Assessment (HTA), Medion, and ARIF (Aggressive Research Intelligence Facility)). We did not restrict studies based on language or publication status, or whether data were collected prospectively or retrospectively. Selection criteria: We included studies that provided the number of true positives, false positives, false negatives, and true negatives for ERCP or IOC. We only accepted studies that confirmed the presence of common bile duct stones by extraction of the stones (irrespective of whether this was done by surgical or endoscopic methods) for a positive test, and absence of common bile duct stones by surgical or endoscopic negative exploration of the common bile duct, or symptom-free follow-up for at least six months for a negative test as the reference standard in people suspected of having common bile duct stones. We included participants with or without prior diagnosis of cholelithiasis; with or without symptoms and complications of common bile duct stones; with or without prior treatment for common bile duct stones; and before or after cholecystectomy. At least two authors screened abstracts and selected studies for inclusion independently. Data collection and analysis: Two authors independently collected data from each study. We used the bivariate model to summarise the sensitivity and specificity of the tests. Main results: We identified five studies including 318 participants (180 participants with and 138 participants without common bile duct stones) that reported the diagnostic accuracy of ERCP and five studies including 654 participants (125 participants with and 529 participants without common bile duct stones) that reported the diagnostic accuracy of IOC. Most studies included people with symptoms (participants with jaundice or pancreatitis) suspected of having common bile duct stones based on blood tests, ultrasound, or both, prior to the performance of ERCP or IOC. Most studies included participants who had not previously undergone removal of the gallbladder (cholecystectomy). None of the included studies was of high methodological quality as evaluated by the QUADAS-2 tool (quality assessment tool for diagnostic accuracy studies). The sensitivities of ERCP ranged between 0.67 and 0.94 and the specificities ranged between 0.92 and 1.00. For ERCP, the summary sensitivity was 0.83 (95% confidence interval (CI) 0.72 to 0.90) and specificity was 0.99 (95% CI 0.94 to 1.00). The sensitivities of IOC ranged between 0.75 and 1.00 and the specificities ranged between 0.96 and 1.00. For IOC, the summary sensitivity was 0.99 (95% CI 0.83 to 1.00) and specificity was 0.99 (95% CI 0.95 to 1.00). For ERCP, at the median pre-test probability of common bile duct stones of 0.35 estimated from the included studies (i.e., 35% of people suspected of having common bile duct stones were confirmed to have gallstones by the reference standard), the post-test probabilities associated with positive test results was 0.97 (95% CI 0.88 to 0.99) and negative test results was 0.09 (95% CI 0.05 to 0.14). For IOC, at the median pre-test probability of common bile duct stones of 0.35, the post-test probabilities associated with positive test results was 0.98 (95% CI 0.85 to 1.00) and negative test results was 0.01 (95% CI 0.00 to 0.10). There was weak evidence of a difference in sensitivity (P value = 0.05) with IOC showing higher sensitivity than ERCP. There was no evidence of a difference in specificity (P value = 0.7) with both tests having similar specificity. Authors' conclusions: Although the sensitivity of IOC appeared to be better than that of ERCP, this finding may be unreliable because none of the studies compared both tests in the same study populations and most of the studies were methodologically flawed. It appears that both tests were fairly accurate in guiding further invasive treatment as most people diagnosed with common bile duct stones by these tests had common bile duct stones. Some people may have common bile duct stones in spite of having a negative ERCP or IOC result. Such people may have to be re-tested if the clinical suspicion of common bile duct stones is very high because of their symptoms or persistently abnormal liver function tests. However, the results should be interpreted with caution given the limited quantity and quality of the evidence.
    Cochrane database of systematic reviews (Online) 02/2015; 2:CD010339. DOI:10.1002/14651858.CD010339.pub2 · 6.03 Impact Factor

Publication Stats

9k Citations
2,048.42 Total Impact Points


  • 1999-2015
    • University College London
      • • Royal Free Hospital
      • • Division of Surgery and Interventional Science
      • • Department of Pathology
      • • Department of Medical Physics and Bioengineering
      Londinium, England, United Kingdom
  • 1994-2015
    • Royal Free London NHS Foundation Trust
      • Department of Radiology
      Londinium, England, United Kingdom
  • 2003-2014
    • Imperial College London
      Londinium, England, United Kingdom
    • University College London Hospitals NHS Foundation Trust
      • Department of Surgery
      Londinium, England, United Kingdom
  • 2002-2014
    • Royal Free Academy of PMC
      Londinium, England, United Kingdom
  • 2013
    • University of Oxford
      Oxford, England, United Kingdom
  • 2012
    • ICL
      Londinium, England, United Kingdom
    • UCL Eastman Dental Institute
      Londinium, England, United Kingdom
    • Sichuan University
      • Department of Neurosurgery
      Chengdu, Sichuan Sheng, China
  • 2011
    • Università degli Studi di Modena e Reggio Emilia
      Modène, Emilia-Romagna, Italy
  • 1996-2010
    • University of London
      Londinium, England, United Kingdom
  • 2009
    • Royal University Hospital
      Saskatoon, Saskatchewan, Canada
    • Imperial College Healthcare NHS Trust
      • Department of Medicine
      Londinium, England, United Kingdom
  • 2008
    • Leeds Teaching Hospitals NHS Trust
      Leeds, England, United Kingdom
  • 2007
    • Oxford University Hospitals NHS Trust
      Oxford, England, United Kingdom
  • 2005
    • University of Leipzig
      • Institute of Anatomy
      Leipzig, Saxony, Germany
    • Federal University of Minas Gerais
      Cidade de Minas, Minas Gerais, Brazil
  • 1997
    • Ealing, Hammersmith & West London College
      Londinium, England, United Kingdom
    • M. K. Haji Orphanage Hospital
      Malappuram, Kerala, India