263 Building the Fiscal Business Case: Cost-Effectiveness of Replacing Pre-Operative MRCP With Intraoperative CBD Ultrasound

Abstract Introduction UK practice is to perform pre-operative magnetic resonance cholangiopancreatography (MRCP) in patients with risk factors to detect CBD stones. Intraoperative laparoscopic ultrasound (IOUS) of the CBD is an alternative diagnostic modality that can be performed during laparoscopic cholecystectomy. This study aimed to evaluate the cost-effectiveness of routine IOUS versus pre-operative MRCP in detecting CBD stones. Method We conducted a retrospective review of all laparoscopic cholecystectomies over 7 years 2018 to early 2025. Key outcomes included Cost effectiveness of the procedure, detection of CBD stones. We compared costs of the two strategies. This was also compared to our previously published data for the years 2015-2018. Results During our study 1065 cases had deranged liver function tests or dilated bile ducts on ultrasound warranting MRCP scan, out of which 47 had preoperative MRCP. 1018 patients were suspected to have common bile duct (CBD) stones, but they had IOUS instead. Only ten patients (0.9 %) required a postoperative MRCP due to signs of retained stones of those only 4 were positive. Showing a sensitivity of 98.9%. The IOUS strategy spared an estimated 1008 peri-operative MRCP scans. The approximate cost of imaging/procedures in the IOUS strategy was £132,000 compared to £368 k for the MRCP-first strategy, spared 420 hours of Magnetic resonance imaging. IOUS use also shortened hospital stay, by enabling definitive one-stop management. Conclusions This approach significantly reduces healthcare costs, avoids delays, and improves patient flow and comfort. Wider adoption of IOUS in gallstone disease management could confer both clinical and economic benefits.