Predictors Of Choledocholithiasis Research Articles

Predictors of Choledocholithiasis in Cholecystectomy Patients and Their Cutoff Values and Prediction Model in Korea in Comparison with the 2019 ASGE Guidelines.

: In 2019, the American Society for Gastrointestinal Endoscopy (ASGE) established clinical predictors for choledocholithiasis. Our study was designed to evaluate these predictors within the Korean clinical context, establish cutoff values, and develop a predictive model. : This retrospective study analyzed patients who underwent laparoscopic cholecystectomy. The relationships between choledocholithiasis and predictors including age, blood tests, and imaging findings were assessed through univariate and multivariate logistic regression analyses. We established Korean cutoff values for these predictors and developed a scoring system for choledocholithiasis using a multivariate logistic regression. The performance of this scoring system was then compared with that of the 2019 ASGE guidelines through a receiver operating characteristic curve. : We established Korean cutoff values for age (>70 years), alanine aminotransferase (>26.5 U/L), aspartate aminotransferase (>28.5 U/L), gamma-glutamyl transferase (GGT; >82.5 U/L), alkaline phosphatase (ALP; >77.5 U/L), and total bilirubin (>0.95 mg/dL). In the multivariate analysis, only age >70 years, GGT >77.5 U/L, ALP >77.5 U/L, and common bile duct dilatation remained significant. We then developed a new Korean risk stratification model from the multivariate analysis, with an area under the curve of 0.777 (95% confidence interval, 0.75 to 0.81). Our model was stratified into the low-risk, intermediate-risk, and high-risk groups with the scores being <1.0, 1.0-5.5, and >5.5, respectively. : Predictors of choledocholithiasis in cholecystectomy patients and their cutoff values in Korean should be adjusted and further studies are needed to develop appropriate guidelines.

Liver function tests as predictors of choledocholithiasis: a scoping review

Liver function tests as predictors of choledocholithiasis: a scoping review

Total bilirubin trend as a predictor of choledocholithiasis in patients with gallstones disease

Background: Many diagnostic parameters represent the presence of a common bile duct (CBD) stone, either pre-intra or post-operatively. It varies from lab work to imaging modalities. In this study, we aim to look for the trend of total bilirubin level and its relation to the presence of CBD stones in patients with gallstone disease. Methods: A retrospective study was conducted at King Saud University Medical City, involving 280 patients admitted through the emergency department; with a picture of gallstones disease associated with high readings of total and direct bilirubin; from 2017 to 2019, the relation of high levels of bilirubin liver enzymes, gamma-glutamyl transferase (GGT), alkaline phosphatase to the presence of CBD stone was established. Results: Out of 280 patients, 96 were male, and 184 were female. Total bilirubin was high in 28 (10%) patients overall, with a higher proportion of patients reporting high total bilirubin among patients with detected CBD stones. First and third total bilirubin measurements recorded a median (IQR) of 19.64 (8.65-39.85), and 15.19 (8.10-29.81), respectively, with a 50% reduction noted among 63 (22.5%) patients of all participants. Moreover, normalization of total bilirubin was reported among 134 (47.9%) patients overall, with normalization reported in more patients with no CBD stones. GGT was found to be the only laboratory test significantly related to choledocholithiasis. Conclusion: High levels of bilirubin and alkaline phosphatase were found as predictors of choledocholithiasis, while other laboratory markers were not. Further imagining studies are warranted to diagnose the presence of CBD stones.

Colecistectomía y trasplante cardíaco

Background:The advances in perioperative care and immunosuppressive treatment resulted in a significant increase in survival of transplant patients; as a result, cholelithiasis is more common in transplant patients.Objective: The aim of this study is to analyze and describe the results obtained in cholecystectomies in heart transplant patients.Material and methods: We selected patients by cross-referencing the databases of heart transplantation and scheduled biliary surgeries, and collected information on their medical history, clinical parameters and laboratory tests, among other data.Results: Between January 1994 and December 2017, 154 heart transplant procedures were performed; mean age was 40 years; 16 underwent laparoscopic cholecystectomy after heart transplantation and were included in this study. There were no complications, readmissions or deaths.Conclusion: Laparoscopic cholecystectomy is safe and is the method of choice for heart transplant patients with cholelithiasis. Intraoperative cholangiography should be performed as the predictors of choledocholithiasis are usually abnormal.

A prospective multicenter analysis from the Pediatric ERCP Database Initiative: predictors of choledocholithiasis at ERCP in pediatric patients

The management of suspected choledocholithiasis remains a challenge in pediatric endoscopy. Several recommendations are available for adult patients; however, it is unknown which pediatric patients are most likely to benefit from ERCP for evaluation of choledocholithiasis. The primary aim of this study was to evaluate adult-based criteria in the evaluation of pediatric patients with choledocholithiasis. A secondary aim was to evaluate the role of conjugated (or direct) bilirubin to improve the sensitivity of detecting choledocholithiasis. This was a prospective multicenter study in pediatric patients as part of the Pediatric ERCP Database Initiative (PEDI) with additional post-hoc analysis of updated guidelines. Patients<19 years of age undergoing ERCP for suspected choledocholithiasis or gallstone pancreatitis were enrolled at participating sites. Ninety-five patients were enrolled (69 with choledocholithiasis confirmed at ERCP and 26 with no stones at ERCP). Adverse event rates were similar in both groups. Specificity ranged from 27% to 91% using adult guidelines, but a sensitivity of only 20% to 69%. The were no significant differences between the 2 groups using preprocedure transabdominal US (P= 1.0). Significant differences between groups were identified using either the total or conjugated bilirubin (P= .02). There was also a significant difference between the stone and no-stone groups when conjugated bilirubin was dichotomized to >2 mg/dL (P= .03). Abdominal imaging and laboratory indices may be used to predict pediatric choledocholithiasis with varying sensitivity and specificity. Pediatric-specific guidelines may allow for improved stone prediction compared with existing adult recommendations.

Su1394 - Prevalence of Pre-Operative Hyperbilirubinemia and Predictors of Choledocholithiasis in Patients with Acute Calculus Cholecystitis

Su1394 - Prevalence of Pre-Operative Hyperbilirubinemia and Predictors of Choledocholithiasis in Patients with Acute Calculus Cholecystitis

706 Predictors of Choledocholithiasis at ERCP in Pediatric Patients: A Report From the Pediatric ERCP Database Initiative (PEDI)

706 Predictors of Choledocholithiasis at ERCP in Pediatric Patients: A Report From the Pediatric ERCP Database Initiative (PEDI)

Endosonography for suspected obstructive jaundice with no definite pathology on ultrasonography

Ultrasonography (US) cannot demonstrate all the etiologies of biliary tract dilatation in patients with jaundice. Thus, we evaluated the etiologic yield of endosonography (EUS) for suspected obstructive jaundice when no definite pathology was found on US. Additionally, we sought to identify the predictors of the most common etiologies. We performed a retrospective review of 123 consecutive patients who had undergone EUS for suspected obstructive jaundice when no definite pathology was identified on US. The most common diagnoses included no pathological obstruction (n=43), pancreatobiliary malignancy (n=41), and choledocholithiasis (n=28). Pancreatobiliary malignancy was associated with common bile duct (CBD) dilatation, and fever and elevated alanine aminotransferase were predictors of choledocholithiasis (p<0.05). The accuracy of EUS was 95.9% (118/123) for overall cause of suspected obstructive jaundice, 100% (40/40) for no pathological finding, 100% (23/23) for ampullary cancer, 100% (13/13) for pancreatic cancer, 75% (3/4) for CBD cancer, and 92.9% (26/28) for choledocholithiasis, respectively. Besides the two patients with focal chronic pancreatitis misdiagnosed as with pancreatic cancer, EUS missed the lesions in one CBD cancer patient and two patients with choledocholithiasis. The overall accuracy of EUS in ascertaining pancreatobiliary malignancy and choledocholithiasis was comparable (97.6%, 40/41 vs. 92.9%, 26/28; p>0.05). Marked CBD dilatation (≥12mm) should remind us of the high risk of malignancy, and the presence of CBD dilatation and fever is suggestive of choledocholithiasis. Negative EUS findings cannot assure any pathological obstruction in patients with clinically suspected obstructive jaundice.

Fatores preditivos de coledocolitíase em doentes com pancreatite aguda biliar

To assess the role of alkaline phosphatase (AP), gamil-glutamyltransferase (gammaGT) and abdominal ultrasound (US) as predictors of choledocholithiasis in patients sustaining acute biliary pancreatitis. Data was prospectively collected during a period of 31 months. Forty patients were included, 30 were female and the mean age was 49 +/- 16. All patients sustaining acute biliary pancreatitis were enrolled. Patients with clinical jaundice and severe pancreatitis were excluded. Serum content of AP and gGT as well as US were assessed at admission and 48 hours before cholecistectomy. All patients underwent intra-operative cholangiography (IOC) or pre-operative endoscopic retrograde cholangiography (ERCP), which was indicated based on the odds of choledocholithiasis. In order to identify the predictors of choledocholithiasis, variables were compared between patients sustaining or not such alteration in cholangiography. Student t, Fisher and chi square tests were used for statistical analysis, considering p<0.05 as significant. Positive (PPV) and negative predictor values (NPV) were calculated for each variable. Upon admission, 15 (37%) patients sustained biliary tract dilatation and 5 (12%) choledocholithiasis at the US. Forty eight hours before the operation, 34 (85%) patients had altered levels of gGT and 16 (40%) of AP. Pre-operative US showed biliary tract dilatation in nine patients and choledocholithiasis in three. ERCP was performed in 15 (37%) cases. Higher PPV (55%) was attributed to pre-operative US, which had also a NPV of 96%. The best predictor of choledocholithiasis in patients sustaining mild acute pancreatitis was the biliary tract dilatation in pre-operative US.

Predictors of choledocholithiasis in patients sustaining gallstones

The aim of this study was to identify clinical, biochemical and ultrasonographic predictors of choledocholithiasis in patients sustaining gallstones assessed by cholangiography. In a prospective study, 148 patients were analyzed regarding clinical, biochemical and ultrasonographic data. All patients underwent cholangiography, either preoperative endoscopic or during cholecystectomy. Each variable was compared between the ones who sustained lithiasis in the biliary tree and the others, in order to find out the predictors of choledocholithiasis. Sensibility, specificity, positive predictive value, negative predictive value (NPV) and accuracy were calculated. Spearman correlation, Odds ratio and logistic regression were employed for the statistical analysis, considering p<0.05 as significant. The variables that showed statistical significance were: presence of jaundice, elevated blood serum levels of alkaline phosphatase, g glutamyltransferase (gamma GT), aspartate aminotransferase, alanine aminotransferase, total bilirrubin, and biliary tract dilatation or choledocholithiasis in the ultrasound. The logistic regression presented an equation capable of predicting the probability of choledocholithiasis based in the variables: jaundice, presence of choledocholithiasis in the ultrasound, and blood levels of gamma GT. The best option to exclude the presence of choledocholithiasis was gamma GT, as it held the higher NPV. Every patient with choledocholithiasis in this sample sustained at least one of the preoperative criteria analyzed. Jaundice and choledocholithiasis at the ultrasound were the best predictors of choledocholithiasis; as well as gamma GT was the most reliable factor to exclude this diagnosis.

Assessment of Indicators for Predicting Choledocholithiasis Before Laparoscopic Cholecystectomy

The objective of this report was to study the sensitivity of indicators used for predicting bile duct stones and their endoscopic removal before laparoscopic cholecystectomy. A retrospective study was conducted on 104 patients who successfully underwent endoscopic retrograde cholangiopancreatogram (ERCP) before laparoscopic cholecystectomy at Riyadh Medical Complex between 1992 and 1994 (1412H-1414H). Six indicatorsâjaundice, biliary pancreatitis, stones in bile duct on sonography, dilated bile duct (>7 mm) on ultrasonography, dilated bile duct with deranged liver function test, and deranged liver function test without jaundiceâwere used for suspecting choledocholithiasis and endoscopic removal before laparoscopic cholecystectomy. Ultrasound correctly predicted bile duct stone in 75%, followed by dilated bile duct with deranged liver function test (46%). Clinical jaundice and biliary pancreatitis were equally sensitive indicators (42% each). Sensitivity of only dilated bile duct on ultrasonography in predicting duct stone was 36%. Deranged liver function without jaundice was the least sensitive (22%) of the predictors. Overall, these indicators correctly diagnosed bile duct stones in 34% of patients. Until laparoscopic exploration of bile duct or a noninvasive technique, such as magnetic resonance cholangiopancreatogram (MRCP), is widely available, these predictors will help in selecting patients with bile duct stones for preoperative removal. Other workers have suggested combining these indicators to improve the predictive value.

Liver test patterns as predictors of choledocholithiasis

Liver test patterns as predictors of choledocholithiasis