Obesity Surgery

, Volume 19, Issue 2, pp 207–210 | Cite as

The Imaging Evaluation of Cholelithiasis in the Obese Patient—Ultrasound vs CT Cholecystography: Our Experience with the Bariatric Surgery Population

  • Tyler NeitlichEmail author
  • Jeffrey Neitlich
Research Article



The purpose of this study was to compare computed tomography (CT) cholecystography and ultrasound for gallstone detection in preoperative bariatric surgery patients.


The study included 16 asymptomatic prebariatric surgery patients. On the same day, each patient underwent abdominal CT 4 h after IV cholecystograffin injection, and gallbladder ultrasound. CT and ultrasounds were reviewed by two independent, blinded radiologists, and scored as follows: no gallstones, possible gallstones, definite gallstones, indeterminate. CT and ultrasound results were compared.


Ultrasound detected definite gallstones in three patients, possible gallstones in one patient, and no gallstones in ten patients. Two scans were considered indeterminate. CT cholecystography detected definite gallstones in six patients, possible gallstones in zero patients, and no gallstones in nine patients, and was indeterminate in one patient. All three patients with gallstones seen sonographically had definite gallstones on CT. The patient with possible gallstones detected sonographically had definite stones detected at CT. One of the two patients with indeterminate ultrasounds had gallstones detected at CT. The other patient had both studies indeterminate. One patient with no gallstones sonographically had definite gallstones at CT. No patients with a negative CT had gallstones seen on ultrasound. Nine patients had no gallstones on either modality.


CT cholecystography is more sensitive and specific for the detection of gallstones in the obese population. CT cholecystography should be considered in place of ultrasound in the preoperative workup of these patients.


Gallstones CT Cholecystography Ultrasound Obesity 


  1. 1.
    Buchwald H, Williams SE. Bariatric surgery worldwide 2003. J Obes Surg. 2004 Oct;14(9):1157–64.CrossRefGoogle Scholar
  2. 2.
    Shiffman ML, Sugerman HJ, Kellum JH, et al. Gallstones in patients with morbid obesity. Relationship to body weight, weight loss and gallbladder bile cholesterol solubility. Int J Obes Relat Metab Disord. 1993 Mar;17(3):153–8.PubMedGoogle Scholar
  3. 3.
    Dhabuwala A, Cannan RJ, Stubbs RS. Improvement in co-morbidities following weight loss from gastric bypass surgery. J Obes Surg. 2000 Oct;10(5);428–35.CrossRefGoogle Scholar
  4. 4.
    Aidonopoulos AP, Papavramidis ST, Zaraboukas TG, Habib HW, Pothoulakis IG. Gallbladder findings after cholecystectomy in morbidly obese patients. J Obes Surg. 1994 Feb;4(1):8–12.CrossRefGoogle Scholar
  5. 5.
    Caruana J, McCabe M, Smith A, Camara D, Mercer M, Gillespie J. Incidence of symptomatic gallstones after gastric bypass: is prophylactic treatment really necessary? Surg Obes Relate Diseases. 2005 Nov–Dec;1(6):564–7.CrossRefGoogle Scholar
  6. 6.
    Mason EE, Renquist KE. Gallbladder management in obesity surgery. J Obes Surg. 2002 April;12(2):222–9.CrossRefGoogle Scholar
  7. 7.
    Fobi M, Lee H, Igwe D, Felahy B, James E, Stanczyk M, Fobi N. Prophylactic cholecystectomy with gastric bypass operation: incidence of gallbladder disease. J Obes Surg. 2002 Jun;12(3):350–3.CrossRefGoogle Scholar
  8. 8.
    O’Brien PE, Dixon JB. A rational approach to cholelithiasis in bariatric surgery, its application to the laparoscopically placed adjustable gastric band. Arch Surg. 2003;138:908–12.CrossRefGoogle Scholar
  9. 9.
    Silidker MS, Cronan JT, Scola FH, Moore MM, Schepps B, Thompson W, Dorfman GS. Ultrasound evaluation of cholelithiasis in the morbidly obese. J Abdominal Imaging. 1988 Dec;13(1):345–6.Google Scholar
  10. 10.
    Dwyer AJ. Matchmaking and McNemar in the comparison of diagnostic modalities. Radiology. 1991;178:328–30.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  1. 1.Department of RadiologyMount Sinai Medical CenterMiami BeachUSA

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