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Case Report

The Significance of Patient Preparedness in Focused Common Bile Duct Ultrasonography for the Diagnosis of Choledocholithiasis

Authors: Nayab Mustansar*, Col. Tariq Saeed Siddiqui, Col. Asma Asghar, Col. Yasser Khan, Maj. Rizwan Rafi and Nazakat Ullah Khan

Publication Date: 04 January, 2025

DOI: https://doi.org/10.51219/MCCRJ/Nayab-Mustansar/164

Citation: Mustansar N, Siddiqui TS, Asghar A, Khan Y, Rafi R, Khan NU. The Significance of Patient Preparedness in Focused Common Bile Duct Ultrasonography for the Diagnosis of Choledocholithiasis. Medi Clin Case Rep J 2025;3(1):637-639.

Copyright:© 2025 Mustansar N, et al., This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract
Choledocholithiasis, the presence of gallstones in the common bile duct, poses a diagnostic challenge due to its varied presentation. Focused Common Bile Duct Ultrasonography (FCBDUS) has emerged as a promising diagnostic tool. However, the significance of patient preparedness in FCBDUS remains underexplored

Objective: This research aims to elucidate the impact of patient preparedness (2-4 hours Fasting and Drinking atleast 2 glass of water before ultrasonography) on the accuracy and efficacy of FCBDUS in diagnosing choledocholithiasis.

Design: It is a cross-sectional prospective study carried out in the Radiology department of CMH Peshawar for a span of five months from January 2024 - May 2024.

Setting: Radiology department of CMH Peshawar. STUDY DURATION: 1st January 2024- 15th May 2024.

Methodology: In this study, a total of 100 patients with suspected choledocholithiasis were selected using non-probability purposive sampling. Out of 100 patients 50 were prepared before FCBDUS and 50 patients were scanned unprepared. Each patient underwent a thorough evaluation, including a medical history review and physical examination. Following this, ultrasounds were performed on each patient in both the supine and right semi-prone positions in both groups of prepared and unprepared patients. An experienced radiologist, with five years of post-specialization experience, assessed the quality of bile duct stone visualization.

Results: The visualization quality of bile duct stones was significantly higher in the right semi-prone position with well-prepared patients as compared to the supine position and unprepared patients before focussed CBD ultrasound. Conclusion: In conclusion, our study demonstrates that the well-prepared patients (fasting of 2-4 hours and good hydration before scan) and in right semi-prone position provides better visualization of bile duct stones compared to the unprepared patients.

Keywords: Common bile duct (CBD); Ultrasound; Supine; Right semioblique position; Choledocholithiasis; Focused Common Bile Duct Ultrasonography; Patient Preparedness; Fasting; Hydration.

Introduction
Choledocholithiasis, characterized by the presence of gallstones within the common bile duct, can lead to serious complications such as cholangitis and pancreatitis1. Timely and accurate diagnosis is crucial for appropriate management2. While various imaging modalities exist, FCBDUS has gained attention for its non-invasiveness, cost-effectiveness and portability3. However, the role of patient preparedness, including fasting status and hydration, remains poorly understood4,5.

Methodology
A prospective analysis was conducted on patients who underwent FCBDUS for suspected choledocholithiasis over a period of five months. Data including patient demographics, fasting duration and hydration status were collected. Statistical analysis was performed to assess the association between patient preparedness factors and FCBDUS accuracy. Patient preparedness include the following:

• Fasting Requirements: One of the primary preparations for CBD ultrasonography is fasting. Fasting for at least 2-4 hours at least before the examination ensures that the gallbladder is distended and reduces the presence of bowel gas, which can obscure the visualization of the bile ducts. Studies have shown that fasting improves the clarity of ultrasound images, thereby enhancing the detection of bile duct stones.

• Hydration Status: Adequate hydration is essential as it helps maintain the echogenicity of the bile duct and surrounding structures, making it easier to identify abnormalities.

Results
Preliminary findings indicate a significant correlation between fasting duration and FCBDUS efficacy. Patients who adhered to recommended fasting guidelines exhibited clearer imaging and higher diagnostic accuracy compared to noncompliant individuals. Hydration status also showed a notable impact, with adequately hydrated patients demonstrating improved visualization of the common bile duct.

Visualization of CBD stones in group A (well prepared before FCBDUS) was cent percent in making exact diagnosis as compared to the non-prepared patient (Group-B). As shown below in (Table 1), (Figure 1).


Table 1: Patient preparedness include the fasting of at least 2-4 hours before the scan and good hydration before the FCBDUS

Patient

Total No. of patients

FCBDUS  CBD  stone

FCBDUS- No CBD stone detected

Accuracy

Preparedness

detected

Well -prepared before FCBDUS

 

 

 

 

 

 

 

 

50

50

0

100%

Not prepared before FCBDUS

 

 

 

 

50

33

17

66%


It can be represented as follows:
Figure 1: It is obvious from the above figure that the well-prepared patients show accurate diagnosis of the CBD stones via FCBDUS as compared to the unprepared patients.

The percentage accuracy can be shown in (Figure 2) below

Figure 2: The Percentage Accuracy of CBD stone Detection

Discussion
The findings underscore the importance of patient preparedness in optimizing FCBDUS for diagnosing choledocholithiasis6. Adequate fasting duration and hydration positively influence image quality, thereby enhancing the sensitivity and specificity of FCBDUS7. These results highlight the need for standardized protocols regarding patient preparation to maximize the utility of FCBDUS in clinical practice8. Proper patient preparedness directly impacts the diagnostic accuracy of CBD ultrasonography9. Inadequate preparation can lead to poor image quality, resulting in missed or false diagnoses of choledocholithiasis10. Ensuring patients are well-prepared can reduce the need for repeat examinations, thereby saving costs and reducing patient exposure to additional procedures and potential delays in diagnosis11,12.

Several studies have highlighted the importance of patient preparation in the success of CBD ultrasonography13,14,15. For instance, a study by Sarwar et al. (2020) demonstrated that patients who adhered to fasting guidelines had significantly higher rates of accurate diagnosis compared to those who did not16. Another study by Gupta et al. (2019) emphasized the role of patient education in reducing anxiety and improving cooperation during the procedure, thereby enhancing image quality and diagnostic yield17.

Conclusion
Patient preparedness significantly influences the diagnostic accuracy of FCBDUS for choledocholithiasis. Establishing guidelines for fasting duration and hydration status can improve imaging quality and enhance the efficacy of FCBDUS as a diagnostic tool. Further prospective studies are warranted to validate these findings and establish standardized protocols for patient preparation in FCBDUS. Patient preparedness plays a critical role in the effectiveness of focused common bile duct ultrasonography for diagnosing choledocholithiasis. Proper fasting, hydration, positioning and psychological readiness contribute to optimal imaging conditions, enhancing the accuracy and reliability of the diagnosis. Continued emphasis on patient education and preparation protocols is essential to improve clinical outcomes and reduce healthcare costs associated with repeat imaging and misdiagnosis.

References

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