Prediction Of Choledocholithiasis Research Articles

Test Performance Characteristics of Dynamic Liver Enzyme Trends in the Prediction of Choledocholithiasis.

(1) Background: Various methods to predict the presence or absence of choledocholithiasis (CDL) have been proposed. We aimed to assess the performance characteristics of dynamic liver enzyme trends in the prediction of CDL. (2) Methods: This was a single-center retrospective cohort study. All adult in-patients undergoing endoscopy for suspected CDL between 1 January 2012 and 7 October 2018 were identified, with patients with prior cholecystectomy, prior sphincterotomy, or indwelling biliary prostheses were excluded. Available laboratory parameters within 72 h preceding the procedure were recorded, allowing for the assessment of trends. Dynamic enzyme trends were defined as any increase or decrease by 30% and 50% within 72 h of the index procedure. (3) Results: A total of 878 patients were included. Mean age was 61.8 years, with 58.6% female. Increases in alkaline phosphatase (ALP) of at least 30% or 50% were both specific for the presence of CDL, with specificities of 82.7% (95% CI 69.7–91.8%) and 88.5% (95% CI 76.6–95.6%), respectively. Decreases in bilirubin or ALP of at least 50% were highly specific for the absence of CDL, with specificities of 91.7% (95% CI 85.7–95.8%) and 100.0% (97.2–100.0%), respectively. (4) Conclusions: Several liver enzyme trends appear to be specific for the absence or presence of stones; in particular, significant decreases in total bilirubin or ALP of at least 30–50% over the prior 72 h appear to be especially predictive of an absence of intraductal findings during endoscopy.

The Diagnostic Value of GGT-Based Biochemical Indicators for Choledocholithiasis with Negative Imaging Results of Magnetic Resonance Cholangiopancreatography.

To reveal the relationship between a group of preoperative biochemical indicators such as GGT, ALP, ALT, AST, TB, and DB and the occurrence of common bile duct stones in patients with negative results of magnetic resonance cholangiopancreatography, a retrospective diagnostic accuracy clinical test is conducted in this study. In order to reduce the missed diagnosis rate of choledocholithiasis and perform more accurate common bile duct exploration, 466 patients who underwent surgical treatment of cholelithiasis from January 2014 to December 2015 have been analyzed retrospectively. Firstly, the confounding factors are corrected through Binary Logistic regression. Then, the diagnostic efficacy of each indicator is measured by the ROC curve among different types of patients. In all patients, the top three individual indicators with the greatest AUC curve area for predicting common bile duct stones can be observed from the results of MRCP, γ-glutamyl transpeptidase, and alkaline phosphatase. Besides, the diagnostic efficiency of the comprehensive evaluation is higher than that of all individual indicators. For MRCP-negative patients, the top three largest AUC curve area of the diagnostic efficacy for choledocholithiasis were GGT, ALP, and DB. For patients who have a suspected diagnosis of secondary choledocholithiasis, the diagnostic efficacy of the combination of imaging results, biochemical indexes, common bile duct width, and other abnormal indicators for choledocholithiasis is much higher than that of the single abnormal biochemical indexes for the prediction of choledocholithiasis. For MRCP-negative patients, GGT, ALP, DB, and the width of common bile duct diameter are valuable for the prediction of common bile duct stones, and GGT is the most valuable diagnostic predictor.

Application of artificial intelligence in pancreaticobiliary diseases.

The role of artificial intelligence and its applications has been increasing at a rapid pace in the field of gastroenterology. The application of artificial intelligence in gastroenterology ranges from colon cancer screening and characterization of dysplastic and neoplastic polyps to the endoscopic ultrasonographic evaluation of pancreatic diseases. Artificial intelligence has been found to be useful in the evaluation and enhancement of the quality measure for endoscopic retrograde cholangiopancreatography. Similarly, artificial intelligence techniques like artificial neural networks and faster region-based convolution network are showing promising results in early and accurate diagnosis of pancreatic cancer and its differentiation from chronic pancreatitis. Other artificial intelligence techniques like radiomics-based computer-aided diagnosis systems could help to differentiate between various types of cystic pancreatic lesions. Artificial intelligence and computer-aided systems also showing promising results in the diagnosis of cholangiocarcinoma and the prediction of choledocholithiasis. In this review, we discuss the role of artificial intelligence in establishing diagnosis, prognosis, predicting response to treatment, and guiding therapeutics in the pancreaticobiliary system.

Особливості діаґностики і лікування малосимптомного холедохолітіазу у пацієнтів з гострим калькульозним холециститом

Aim. Developing optimal approaches in the diagnostic algorithm and treatment of patients with acute calculous cholecystitis complicated by oligosymptomatic choledocholithiasis. Material and Methods. The results of treatment of 215 patients with acute calculous cholecystitis complicated by oligosymptomatic choledocholithiasis were analyzed, 166 of which-were studied retrospectively, and 49 - prospectively. Female patients predominated (74.0%); the average age was 56.0±1.06 years. Blood serum biochemistry, transabdominal ultrasound, magnetic resonance cholangiopancreatography, and blood and bile microRNA were used for the diagnosis. Results and Discussion. After verification of the diagnosis by applying several tests and developed multivariate models based on determining the blood and bile microRNA, and the model consisting of 5 factors for the prediction of the presence of choledocholithiasis (alkaline phosphatase, AST, ALT, total bilirubin, the common bile duct diameter according to transabdominal ultrasound), the main therapeutic option to resolve biliary duct problems in 183 (85.1%) patients were endoscopic retrograde cholangiography (ERC) with sphincterotomy and stone extraction. In the second step, 159 (74.0%) patients underwent laparoscopic cholecystectomy. One-step interventions (laparoscopic cholecystectomy and stones removal / intraoperative therapeutic ERC) due to association with acute cholecystitis changes in the hepatoduodenal ligament were performed on 7 (3.3%) patients only. Conclusions. In patients with acute calculous cholecystitis, using a 5-factor model has a fairly high prognostic value for the prediction of choledocholithiasis, and the additional use of quantifying the expression levels of miRNA-122 and miRNA-21 significantly improves the diagnosis of asymptomatic choledocholithiasis. The optimal approach to the treatment of such patients is to perform therapeutic ERCP followed by laparoscopic cholecystectomy. Keywords: acute calculous cholecystitis, oligosymptomatic choledocholithiasis, transabdominal ultrasound, endoscopic retrograde cholangiopancreatography, laparoscopic cholecystectomy

Selective Intraoperative Transcystic Cholangiogaraphy in Laparoscopic Cholecystectomy, 3 Years' Experience

Background: Use of intraoperative cholangiography (IOC), a contrast-based examination of the biliary system during laparoscopic cholecystectomy (LC) still represents a valuable approach to illustrate biliary duct anatomy, diagnose obstruction and avoid complications. Objective: The aim of work was to detect the advantages of IOC when used in selected cases during LC in diagnosis of biliary obstruction and prevention of biliary injuries. Patients and methods: 29 patients with specific criteria were included in the study to perform LC and IOC after preoperative magnetic resonance cholangio pancreatogaraphy (MRCP). Follow-up was done by clinical examination, serum bilirubin and U/S for one year. Collected data had been statistically analyzed. Results: IOC resulted in significant increase in mean surgical time with longer time in cases with pericholecystic fluid and mucocele. IOC still has a higher specificity, sensitivity and positive predictive value (PPV) (100, 87.5&100% respectively) over MRCP (65, 77.8&50% respectively) in prediction of choledocholithiasis. U/S, MRCP & IOC had high negative predictive values (NPV), good negative tests. History of obstructive jaundice had a low sensitivity, specificity and PPV (71.5, 63.6&38.5) but had a high NPV (87.5%) in detection of choledocholithiasis. Normal IOC saved 8 patients with history of obstructive jaundice from unnecessary endoscopic retrograde cholangiopancreatography (ERCP). No biliary injuries had been reported. Conclusion: selective IOC in high risk patients is useful in detection of choledocholithiasis, avoidance of ERCP in patients with non-specific common bile duct (CBD) dilatation and prevention of biliary injuries in cases with high risk for injury.

Prediction of Choledocholithiasis in Cholecystectomized Patients Before Endoscopic Ultrasound

Prediction of Choledocholithiasis in Cholecystectomized Patients Before Endoscopic Ultrasound

Acute biliary pancreatitis: Prediction of choledocholithiasis and the need for preoperative ERCP in the laparoscopic era

Acute biliary pancreatitis: Prediction of choledocholithiasis and the need for preoperative ERCP in the laparoscopic era

Role of Endoscopic Retrograde Cholangiopancreatography Before and After Laparoscopic Cholecystectomy

While the role of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) in the diagnosis and management of choledocholithiasis is well established, this study evaluates the usefulness of ERCP and EST in patients with symptomatic cholecystolithiasis and suspected choledocholithiasis before undergoing laparoscopic cholecystectomy (LC), and the role of ERCP-EST in the management of complications resulting from LC. This paper reviews retrospectively our experience from 1992 to 1995. A total of 1221 LCs and 717 ERCPs were performed, out of which 257 ERCPs were performed on 225 patients who underwent LC (230 ERCPs before and 27 after). The age range was 10-85 years (mean 43.5). The study group comprised 148 females (66%) and 77 males (34%). The overall success rate for ERCP was 92% (96% for diagnostic and 88% for therapeutic). Choledocholithiasis was found at preoperative ERCP in 45% of cases. Prediction of choledocholithiasis was accurate in 46%, based on abnormal liver chemistry, and 70% when based on a combination of abnormal liver tests and dilated main bile duct (>7 mm) by ultrasound. In 40 cases of acute biliary pancreatitis, choledocholithiasis was found at ERCP in eight cases (20%). In the post-LC group, all eight cases with residual stones and seven of eight cases with bile leaks were successfully treated endoscopically. There were four cases with major duct injuries that required surgical management. The complications related to ERCP-EST included two cases of bleeding post-EST (one was controlled with injection therapy and the second one was managed surgically), and three cases of mild pancreatitis. ERCP and EST are effective and safe in the diagnosis and management of choledocholithiasis, and facilitate LC for symptomatic cholelithiasis. The procedures are also valuable in the diagnosis and management of most complications resulting from LC.