Joana Magalhães1, Bruno Rosa1, José Cotter1. 1. Joana Magalhães, Bruno Rosa, José Cotter, Gastroenterology Department, Centro Hospitalar do Alto Ave, 4835-044 Guimarães, Portugal.
Abstract
AIM: To study the practical applicability of the American Society for Gastrointestinal Endoscopy guidelines in suspected cases of choledocholithiasis. METHODS: This was a retrospective single center study, covering a 4-year period, from January 2010 to December 2013. All patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for suspected choledocholithiasis were included. Based on the presence or absence of predictors of choledocholithiasis (clinical ascending cholangitis, common bile duct (CBD) stones on ultrasonography (US), total bilirubin > 4 mg/dL, dilated CBD on US, total bilirubin 1.8-4 mg/dL, abnormal liver function test, age > 55 years and gallstone pancreatitis), patients were stratified in low, intermediate or high risk for choledocholithiasis. For each predictor and risk group we used the χ(2) to evaluate the statistical associations with the presence of choledocolithiasis at ERCP. Statistical analysis was performed using SPSS version 21.0. A P value of less than 0.05 was considered statistically significant. RESULTS: A total of 268 ERCPs were performed for suspected choledocholithiasis. Except for gallstone pancreatitis (P = 0.063), all other predictors of choledocholitiasis (clinical ascending cholangitis, P = 0.001; CBD stones on US, P ≤ 0.001; total bilirubin > 4 mg/dL, P = 0.035; total bilirubin 1.8-4 mg/dL, P = 0.001; dilated CBD on US, P ≤ 0.001; abnormal liver function test, P = 0.012; age > 55 years, P = 0.002) showed a statistically significant association with the presence of choledocholithiasis at ERCP. Approximately four fifths of patients in the high risk group (79.8%, 154/193 patients) had confirmed choledocholithiasis on ERCP, vs 34.2% (25/73 patients) and 0 (0/2 patients) in the intermediate and low risk groups, respectively. The definition of "high risk group" had a sensitivity of 86%, positive predictive value 79.8% and specificity 56.2% for the presence of choledocholithiasis at ERCP. CONCLUSION: The guidelines should be considered to optimize patients' selection for ERCP. For high risk patients specificity is still low, meaning that some patients perform ERCP unnecessarily.
AIM: To study the practical applicability of the American Society for Gastrointestinal Endoscopy guidelines in suspected cases of choledocholithiasis. METHODS: This was a retrospective single center study, covering a 4-year period, from January 2010 to December 2013. All patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for suspected choledocholithiasis were included. Based on the presence or absence of predictors of choledocholithiasis (clinical ascending cholangitis, common bile duct (CBD) stones on ultrasonography (US), total bilirubin > 4 mg/dL, dilated CBD on US, total bilirubin 1.8-4 mg/dL, abnormal liver function test, age > 55 years and gallstone pancreatitis), patients were stratified in low, intermediate or high risk for choledocholithiasis. For each predictor and risk group we used the χ(2) to evaluate the statistical associations with the presence of choledocolithiasis at ERCP. Statistical analysis was performed using SPSS version 21.0. A P value of less than 0.05 was considered statistically significant. RESULTS: A total of 268 ERCPs were performed for suspected choledocholithiasis. Except for gallstone pancreatitis (P = 0.063), all other predictors of choledocholitiasis (clinical ascending cholangitis, P = 0.001; CBD stones on US, P ≤ 0.001; total bilirubin > 4 mg/dL, P = 0.035; total bilirubin 1.8-4 mg/dL, P = 0.001; dilated CBD on US, P ≤ 0.001; abnormal liver function test, P = 0.012; age > 55 years, P = 0.002) showed a statistically significant association with the presence of choledocholithiasis at ERCP. Approximately four fifths of patients in the high risk group (79.8%, 154/193 patients) had confirmed choledocholithiasis on ERCP, vs 34.2% (25/73 patients) and 0 (0/2 patients) in the intermediate and low risk groups, respectively. The definition of "high risk group" had a sensitivity of 86%, positive predictive value 79.8% and specificity 56.2% for the presence of choledocholithiasis at ERCP. CONCLUSION: The guidelines should be considered to optimize patients' selection for ERCP. For high risk patients specificity is still low, meaning that some patients perform ERCP unnecessarily.
Entities:
Keywords:
Cholangitis; Choledocholithiasis; Common bile duct stones; Dilated common bile duct; Endoscopic retrograde cholangiopancreatography
Authors: John T Maple; Tamir Ben-Menachem; Michelle A Anderson; Vasundhara Appalaneni; Subhas Banerjee; Brooks D Cash; Laurel Fisher; M Edwyn Harrison; Robert D Fanelli; Norio Fukami; Steven O Ikenberry; Rajeev Jain; Khalid Khan; Mary Lee Krinsky; Laura Strohmeyer; Jason A Dominitz Journal: Gastrointest Endosc Date: 2010-01 Impact factor: 9.427
Authors: Niels G Venneman; Erik Buskens; Marc G H Besselink; Susanne Stads; Peter M N Y H Go; Koop Bosscha; Gerard P van Berge-Henegouwen; Karel J van Erpecum Journal: Am J Gastroenterol Date: 2005-11 Impact factor: 10.864
Authors: Chung Yao Yu; Nitzan Roth; Niraj Jani; Jaehoon Cho; Jacques Van Dam; Rick Selby; James Buxbaum Journal: Surg Endosc Date: 2019-03-25 Impact factor: 4.584
Authors: Christina J Sperna Weiland; Evelien C Verschoor; Alexander C Poen; Xavier J M N Smeets; Niels G Venneman; Abha Bhalla; Ben J M Witteman; Hester C Timmerhuis; Devica S Umans; Jeanin E van Hooft; Marco J Bruno; P Fockens; Robert C Verdonk; Joost P H Drenth; Erwin J M van Geenen Journal: Surg Endosc Date: 2022-09-26 Impact factor: 3.453
Authors: Mauro Ariel Capparelli; Pablo Damian D Alessandro; Horacio Alberto Questa; Victor Hugo Ayarzabal; Maria Marcela Bailez; Marcelo Eugenio Barrenechea Journal: Pediatr Surg Int Date: 2021-06-19 Impact factor: 1.827
Authors: Catarina Gouveia; Rui Loureiro; Rosa Ferreira; Alexandre Oliveira Ferreira; António Alberto Santos; Maria Pia Costa Santos; Carolina Palmela; Marília Cravo Journal: GE Port J Gastroenterol Date: 2017-09-15
Authors: Ausra Aleknaite; Gintaras Simutis; Juozas Stanaitis; Jonas Valantinas; Kestutis Strupas Journal: United European Gastroenterol J Date: 2017-09-06 Impact factor: 4.623