SP4.13 Use of MRCP in the Management of Patients with Symptomatic Gallstones and Low-to-Moderate Risk of CBD Stones: A Retrospective Audit guided by The SUNFLOWER Study Protocol

Aims To evaluate the role of preoperative MRCP in detecting choledocholithiasis in patients with symptomatic gallstones and compare its utility against expectant management Methods A 12-month retrospective review (January–December 2024) was conducted, focusing on patients at low-to-moderate risk of CBD stones. Exclusion criteria included known CBD stones, CBD diameter ≥7mm, bilirubin ≥50 µmol/L, or ALT/ALP >3× normal. MRCP findings, ERCP interventions, and postoperative outcomes were analysed. Results Of one hundred and seventy-two patients undergoing MRCP, seventy-two met low-to-moderate risk criteria. Mean admission values were: total bilirubin 24.2 µmol/L [5–49 µmol/L], ALT 218.4 U/L [12–1237 U/L], and ALP 129.2 U/L [34–378 U/L]. MRCP identified CBD dilation [mean 8.2mm] in twenty patients, with five showing CBD stones. Three underwent ERCP within 1–7 days, while two had repeat imaging [MRCP/EUS] showing no stones. All underwent laparoscopic cholecystectomy within 1–54 days post-admission. Postoperative complications included one retained CBD stone requiring ERCP and one gallbladder collection. Discussion MRCP identified choledocholithiasis in 6.9% of low-to-moderate-risk patients, but false positives led to unnecessary investigations. Given the low rate of retained stones, expectant management may be a viable alternative to routine MRCP. Further investigation would involve investigating the outcomes of expectant management for comparative analysis; from which cost-benefit analysis can be conducted with the aims of standardising imaging practises within the department.