The author’s technique of liver elastography in patients with postcholecystectomy syndrome: reproducibility opportunities

DOI: 10.47026/2413-4864-2025-1-1-12

UDC: 616.366-089.87
BBC: 54.135

Borsukov A.V., Mamoshin A.V., Shestakova D.Yu., Dolgaya M.I., Shaeva A.V.

The author's technique of liver elastography in patients with postcholecystectomy syndrome: reproducibility opportunities

Keywords: postcholecystectomy syndrome, elastography, compression elastography, two-dimensional shear wave elastography

Postcholecystectomy syndrome is a complicated symptom complex of functional genesis observed in a number of patients after undergoing cholecystectomy. To diagnose the postcholecystectomy syndrome, patients are examined in several stages, and surgical intervention is used to treat complications of postcholecystectomy syndrome. That is why it is very important to diagnose abnormalities in the biliary system functioning in a timely manner in order to avoid an increase in the number of surgical corrections for the complicated course of the postcholecystectomy period. Initially, abnormalities developing in the biliary system after cholecystectomy may not be amenable to diagnosis according to the applicable algorithm, and all indicators, including laboratory and instrumental ones, are not sensitive to incipient changes. Liver elastography is one of modern methods of examining the hepatic parenchyma stiffness used in patients with postcholecystectomy syndrome. This method, unlike ultrasound, enables to measure the degree of fibrosis and, at the early stages of liver structure changes, indicate emerging problems with the hepatobiliary system. The aim of the study was to evaluate the clinical and diagnostic opportunities of the author's liver elastography technique in the study of patients with postcholecystectomy syndrome. Materials and methods. All patients with postcholecystectomy syndrome were examined by the method developed by us (group 1) and by the method adopted in the medical institution earlier (group 2). Group 1 consisted of patients with a history of cholecystectomy (n = 27, 51.9%), examined by protocols according to clinical recommendations, which include magnetic resonance cholangiopancreatography, biochemical blood analysis (alanine aminotransferase, aspartate aminotransferase, bilirubin, alkaline phosphatase), multiparametric ultrasound (B-mode, shear wave elastography in all areas of interest). Despite a sufficient number of advantages, this diagnostic algorithm has a number of disadvantages: significant time required for conducting the study, lack of diagnostic sensitivity at the initial stages of changes in the biliary system (clinical manifestations are not pronounced or expressed insignificantly, laboratory data are within normal values). Group 2 consisted of patients with a history of cholecystectomy (n = 25, 48.1%). Statistical processing of the data obtained was carried out using Statistica 7, Statistical Package for the Social Sciences – 10, ROC analysis (receiver operating characteristics), receiver operating characteristic analysis (MedCalc) comparative test with 95% confidence interval. Results. The patients’ examination was carried out according to our proposed methodology and included two main stages and one additional one. The first stage was to perform compression elastography to determine the areas of greatest stiffness that are localized in postcholecystectomy syndrome in segments VI or VII. The second (main) step was to perform two-dimensional shear wave elastography. Areas of interest: VI–VIII segments, IV–V, II–III and a fragment of segment I, performing at least three measurements. When analyzing the data obtained, all groups of factors (patient-dependent, hardware-dependent, operator-dependent) affecting the final result were taken into account. The third (additional) stage was using the algorithm that we developed: performing compression elastography of the liver in patients with postcholecystectomy syndrome, evaluating the results, then performing two–dimensional shear wave elastography, where the indicators of two-dimensional shear wave elastography of the liver were accurately assessed in the area of the greatest stiffness localization by the data of compression elastography, respectively VI-VIII segments. Then, the time spent on the same study using routine and the author's methods was analyzed; their awareness (the number of false positive and false negative results) and reproducibility were evaluated. At the examination stage, doctors were given the opportunity to work using two diagnostic algorithms: in accordance with the clinical recommendations and according to the author's methodology proposed by us. The first algorithm did not cause difficulties with reproducibility (the examination time varied and averaged about 30 minutes). The study time for the second algorithm exceeded the time of the first one (33 minutes on average per study). However, the total time spent on the study was reduced due compliance with the study stages according to our proposed algorithm (the time spent according to the author's research methodology was 19 minutes). According to the results of the study, the number of false positive and false negative results was estimated for the technique corresponding to clinical recommendations (25% and 40%, respectively), and the author's technique (15% and 25%, respectively). Therefore, the algorithm that we proposed provides significant diagnostic information when examining groups of patients with postcholecystectomy syndrome. Conclusions. The proposed technique of combining compression and two-dimensional shear wave elastography in patients with postcholecystectomy syndrome increases its reproducibility and reduces the number of false positive and false negative results, which contributes to the correct choice of treatment tactics.

References

Agafonova N.A. Postkholetsistektomicheskii sindrom: voprosy diagnostiki i lecheniya [Postcholecystectomy syndrome: issues of diagnosis and treatment]. Moscow, Prima Print, 2015, 68 p.
Repin V.M., Popov A.V., Mikryukov V.Yu., Vagner T.E. Algoritm diagnostiki i lecheniya bol’nykh postkholetsistektomicheskim sindromom [Algorithm of diagnosis and treatment of patients with postcholecystectomy syndrome]. Permskii meditsinskii zhurnal, 2013, no. 5, pp. 21–26.
Borsukov A.V. Elastografiya sdvigovykh voln. Analiz klinicheskikh primerov [Shear wave elastography. Analysis of clinical examples]. Moscow, 2022, 468 p.
Vasil’ev A.Yu., Ratnikov V.A. Diagnosticheskie vozmozhnosti magnitno-rezonansnoi kholangiografii v vyyavlenii zabolevanii zhelchnogo puzyrya i zhelchnykh protokov [Diagnostic capabilities of magnetic resonance cholangiography in the detection of gallbladder and bile duct diseases]. Kazanskii meditsinskii zhurnal, 2004, no. 3, pp. 184–186.
Vasil’ev A.Yu. Magnitno-rezonansnaya kholangiografiya v diagnostike zabolevanii zhelchevyvodyashchikh putei [Magnetic resonance cholangiography in the diagnosis of biliary tract diseases]. Moscow, Nauka Publ., 2006, 197 p.
Gerbali O.Yu., Puchkov K.V., Puchkov D.K. Varianty klinicheskogo techeniya postkholetsistektomicheskogo sindroma pri soputstvuyushchikh zabolevaniyakh organov bryushnoi polosti [Variants of the clinical course of postcholecystectomy syndrome with comorbidities of abdominal organs] Endoskopicheskaya khirurgiya, 2015, no. 2, pp. 26–29.
Danilova O.I., Kaportseva V.S., Pimanov S.I. Vozmushchayushchie faktory pri ul’trazvukovoi elastografii pecheni. Chast’ 2. Iskazhenie rezul’tatov izmerenii vsledstvie osobennostei sosto-yaniya organizma i vneshnikh vozdeistvii [Disturbing factors in ultrasound elastography of the liver. Part 2. Distortion of measurement results due to the peculiarities of the state of the body and external influences]. Vestnik Vitebskogo gosudarstvennogo ordena Druzhby narodov meditsinskogo universiteta, 2023, no. 2, pp. 9–17.
Bochkar’I.A., Nartov E.O., Romantsov V.V., Bazlov B. Zdorov’esberegayushchie tekhnologii: opyt sovremennosti i perspektivy budushchego [Health-saving technologies: modern experience and future prospects]. In: Sovershenstvovanie podkhodov k profilaktike i lecheniyu postkholetsistektomicheskogo sindroma: sb. materialov I mezhregional’noi nauchno-prakticheskoi konferentsii molodykh uchenykh s mezhdunarodnym uchastiem [Proc. of. 1^st Int. Sci. Conf. «Improving approaches to the prevention and treatment of postcholecystectomy syndrome»]. Krasnodar, 2022, pp. 248–252.
Ivashkin V.T., Okhlobystin A.V., Bordin D.S. Sovremennyi vzglyad na problemu postkholetsistektomicheskogo sindroma [Modern view on the problem of postcholecystectomy syndrome]. Rossiiskii zhurnal gastroenterologii, gepatologii, koloproktologii, 2017, no. 6, pp. 96–108.
Ivashkin V.T., Maev I.V., Barankskaya E.K. Klinicheskie rekomendatsii. Rekomendatsii Ros-siiskoi gastroenterologicheskoi assotsiatsii po diagnostike i lecheniyu zhelchnokamennoi bolezni [Clinical recommendations. Recommendations of the Russian Gastroenterological Association on the diagnosis and treatment of gallstones]. Moscow, GEOTAR-Media , 2016, 182 p.
Ivashkin V.T., Lapina T.L. Gastroenterologiya: Natsional’noe rukovodstvo [Gastroenterology: A national manua]. Moscow, GEOTAR-Media Publ., 2008, 700 p.
Laptev V.V., Tskaev A.Yu, Givirovskaya N.E. Metody diagnostiki i lechenie bol’nykh s postkholetsistektomicheskim sindromom [Methods of diagnosis and treatment of patients with postcholecystectomy syndrome]. Russkii meditsinskii zhurnal, 2009, no. 5, p. 357.
Osipov L.V. Tekhnologii elastografii v ul’trazvukovoi diagnostike [Elastography technologies in ultrasound diagnosis]. Meditsinskii alfavit, 2013, no. 3-4, pp. 5–21.
Kashchenko V.A., Loit A.A., Solonitsyn E.G. et al. Rol’ magnitno-rezonansnoi kholangiopankreatografii v predoperatsionnoi diagnostike kholedokholitiaza u patsientov, gotovyashchikhsya k laparoskopicheskoĭ kholetsistektomii [The role of magnetic resonance cholangiopancreatography in the preoperative diagnosis of choledocholithiasis in patients preparing for laparoscopic cholecystectomy]. Vestnik Eksperimental’noi i klinicheskoi khirurgii, 2015, no. 8, pp. 92–96.
Ivashkin V.T., Okhlobystin A.V., Bordin D.S. et al. Sovremennyi vzglyad na problemu postkholetsistektomicheskogo sindroma [Modern view on the problem of postcholecystectomy syndrome]. Rossiiskii zhurnal gastroenterologii, gepatologii, koloproktologii, 2017, no. 27(6), pp. 96–108.
Nersesov A.V., Kaibullaeva D.A., Vasnev O.S. et al. Sovremennyi vzglyad na problemu postkholetsistektomicheskogo sindroma (po materialam Ekspertnogo soveta, sostoyavshegosya 4 maya 2019 g. v gorode Almaty, Kazakhstan) [Modern view on the problem of postcholecystectomy syndrome]. Farmakoekonomika, 2020, no. 13, pp. 205–219.
Borsukov A.V., Amosov V.I., Bus’ko E.A. et al. Ul’trazvukovaya elastografiya: kak delat’ pravil’no [Ultrasound elastography: how to do it right]. Smolensk, 2018, 120 p.
Fomina S.V., Zorkal’tsev M.A. Ul’trazvukovaya elastografiya [Ultrasound elastography]. Tomsk, 2024, 42 p.
Tsimmerman Ya.N. Postkholetsistektomicheskii sindrom, ego sushchnost’, klinicheskie proyavleniya, diagnostika i lechenie [Postcholecystectomy syndrome, its essence, clinical manifestations, diagnosis and treatment]. Eksperimental’naya i klinicheskaya gastroenetrologiya, 2017, no. 2, pp. 96–108.
Kim H., Han I.W., Heo J.S., Oh M.G. Postcholecystectomy syndrome: symptom clusters after lap-aroscopic cholecystectomy [Postcholecystectomy syndrome: symptom clusters after laparoscopic cholecystectomy]. Ann Surg Treat Res, 2018, no. 3, pp. 135–140.

About authors

Borsukov Aleksey V.: Doctor of Medical Sciences, Professor, Head of the Problem Research Laboratory «Diagnostic Studies and Minimally Invasive Technologies», Smolensk State Medical University, Russia, Smolensk (bor55@yandex.ru; ORCID: https://orcid.org/0000-0003-4047-7252)

Mamoshin Andrian V.: Doctor of Medical Sciences, Associate Professor, Senior Researcher, Department of Abdominal Surgery of the Department of Thoracoabdominal Oncosurgery, Vishnevsky National Medical Research Center of Surgery, Russia, Moscow; Senior Researcher, Scientific and Technological Center for Biomedical Photonics, Professor, Department of Specialized Surgical Disciplines, Orel State University named after I.S. Turgenev, Russia, Orel (dr.mamoshin@mail.ru; )

Shestakova Darya Yu.: Candidate of Medical Sciences, Senior Researcher, Problem Research Laboratory «Diagnostic Studies and Minimally Invasive Technologies», Smolensk State Medical University, Russia, Smolensk (daria@venidiktova.ru; ORCID: https://orcid.org/0000-0001-5497-1476)

Dolgaya Marina I.: Research Assistant, Problem Research Laboratory «Diagnostic Studies and Minimally Invasive Technologies», Smolensk State Medical University, Russia, Smolensk (mary.dolgaya@yandex.ru; )

Shaeva Anastasiya V.: Ultrasound Diagnostics Doctor, Voronezh Regional Clinical Oncological Dispensary, Russia, Voronezh (boofee@yandex.ru; )

Article link

Borsukov A.V., Mamoshin A.V., Shestakova D.Yu., Dolgaya M.I., Shaeva A.V. The author’s technique of liver elastography in patients with postcholecystectomy syndrome: reproducibility opportunities [Electronic resource] // Acta medica Eurasica. – 2025. – №1. P. 1-12. – URL: https://acta-medica-eurasica.ru/en/single/2025/1/1/. DOI: 10.47026/2413-4864-2025-1-1-12.

Single article

Borsukov A.V., Mamoshin A.V., Shestakova D.Yu., Dolgaya M.I., Shaeva A.V.