Assessment of Indicators for Predicting Choledocholithiasis Before Laparoscopic Cholecystectomy

Alam, Manawwer

doi:10.5144/0256-4947.1998.511

Cited by 6 publications

(7 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The parameters that exhibited significance in the multivariate analysis were subsequently included in the scoring system, and a weighted score was assigned to the different variables based on their prediction accuracy (in this study) and their reported significance in the existing literature. 9 – 16 The presence of a CBD acoustic shadow during ultrasonography, a CBD diameter of >10 mm, alkaline phosphatase levels of ≥200 IU, alanine transaminase levels of ≥220 IU, elevated serum bilirubin levels, and a male age of ≥50 years were significantly correlated with the presence of choledocholithiasis. Subgroup analyses of each predictive variable revealed a 94.7% PPV for a positive acoustic shadow, an 80% PPV for a CBD diameter of >10 mm, a 75% PPV for alkaline phosphatase levels of ≥200 IU, a 71% PPV for alanine transaminase levels of ≥220 IU, a 69% PPV for elevated serum total bilirubin levels, and a 75% PPV for male age of ≥50 years .…”

Section: Resultsmentioning

confidence: 99%

“…Interestingly, the sensitivity of ultrasonography increases when liver function tests indicate an obstructive pattern. 9 , 29 Similarly, levels of alanine transaminase also have a strong predictive value, although their significance has only been evaluated in a few studies. 8 In contrast, elevated serum bilirubin has been strongly linked to the presence of choledocholithiasis.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, imaging techniques (magnetic resonance cholangiopancreatography [MRCP], endoscopic ultrasound [EUS], and endoscopic retrograde cholangiopancreatography [ERCP]) are often used to investigate choledocholithiasis. 9 – 15 However, these imaging techniques are complicated, are associated with risks of morbidity and mortality, lead to operative delays, are expensive, and have accessibility-related challenges. 11 For example, ERCP is known to increase the patient’s risk of morbidity and mortality.…”

mentioning

confidence: 99%

“… 11 For example, ERCP is known to increase the patient’s risk of morbidity and mortality. 9 The use of MRCP is often limited by its high cost and long waiting lists, and EUS is an invasive technique. 12 , 16 Intraoperative cholangiography (IOC) is a relatively simple test, although it is also associated with an increased operative time and risk of morbidity.…”

mentioning

confidence: 99%

“… 1 , 6 , 11 – 15 Unfortunately, there are currently no blood tests that can accurately detect choledocholithiasis among patients with gallstones, although a limited number of predictive systems have been proposed in the literature. 4 , 5 , 9 , 15 For example, Jovanovic et al assessed the need for therapeutic ERCP using biochemical and ultrasonography findings, 4 but the predictive accuracy of these models remains far from satisfactory. 13 , 14 In this study, we aimed to develop a scoring system for the prediction of choledocholithiasis, by using patients’ biochemical profiles and ultrasonography findings.…”

mentioning

confidence: 99%

See 4 more Smart Citations

A scoring system for the prediction of choledocholithiasis: a prospective cohort study

Al-Jiffry

Khayat²,

Abdeen³

et al. 2016

Annals of Saudi Medicine

View full text Add to dashboard Cite

BACKGROUNDTechniques for diagnosing choledocholithiasis pose significant morbidity and mortality risks.OBJECTIVESWe aimed to develop and validate a clinical scoring system for predicting choledocholithiasis.DESIGNData from a prospectively maintained database of all patients with gallstones.SETTINGPatients were admitted to the general surgery department of a military hospital.PATIENTS AND METHODSWe enrolled consecutive patients with symptomatic gallstones, biliary pancreatitis, obstructive jaundice, or cholangitis, who subsequently underwent biochemical testing and ultrasonography. A predictive model was developed from a scoring system using their imaging and laboratory data. Endoscopic retrograde cholangiopancreatography (ERCP) or intraoperative cholangiography were used for confirmatory diagnoses. The predictive efficacy of the scoring system was validated using a retrospective cohort of 272 patients.MAIN OUTCOME MEASURESPredictive accuracy of the scoring system.RESULTSWe enrolled 155 patients in the development group. The common bile duct diameter, alkaline phosphatase of ≥200 IU, elevated bilirubin levels, alanine transaminase of ≥220 IU, and male age of ≥50 years were significantly associated with choledocholithiasis and were included in the scoring system. Ninety-six patients (35%) had scores of ≥8 (high risk), 86 patients (32%) had scores of 4–7 (intermediate risk), and 27 patients (10%) had scores of 1–3 (low risk). In the validation cohort, the positive predictive value for a score of ≥8 was 91.7%, and the scoring system had an area under the curve of 0.896.CONCLUSIONScores of ≥8 were strongly correlated with choledocholithiasis in the developmental and validation groups, which indicates that our scoring system may be useful for predicting the need for therapeutic ERCP. However, prospective validation in a large multicenter cohort is needed to fully understand the benefits of the system.LIMITATIONSThe retrospective validation cohort might have introduced selection and observational biases. The study may have been underpowered because of the sample size of the developmental cohort. The delay between admission and the time of ERCP theoretically may have increased the number of negative ERCP results, but our false negative rate for ERCP was consistent with the previously reported rates.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

A scoring system for the prediction of choledocholithiasis: a prospective cohort study

Al-Jiffry

Khayat²,

Abdeen³

et al. 2016

Annals of Saudi Medicine

View full text Add to dashboard Cite

show abstract

Biochemical and ultrasound parameters may help predict the need for therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in patients with a firm clinical and biochemical suspicion for choledocholithiasis

Jovanović

Salkić

Zerem

et al. 2011

European Journal of Internal Medicine

View full text Add to dashboard Cite

Does preoperative magnetic resonant cholangiopancreatography (MRCP), improve the safety of laparoscopic cholecystectomy?

Al-aubaidi

Ghadhban

Chitheer

2018

International Journal of Surgery Open

View full text Add to dashboard Cite

Background: Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive imaging test with excellent overall sensitivity and specificity for demonstrating the level and the presence of a biliary obstruction. MRCP has emerged as an accurate, diagnostic modality for investigating the biliary and pancreatic duct. In some cases, it has been recommended that preoperative MRCP is a good choice for the detection of CBD stones. Aim: The aim of the study is to assess the value of preoperative MRCP on the safety of laparoscopic cholecystectomy. Methods: The randomized study was carried out on 100 patients aged 16–65 years, admitted in Baghdad Teaching Hospital between 2013 and 2015. Laparoscopic cholecystectomy was performed for them. 45 patients had preoperative MRCP followed by conventional laparoscopic cholecystectomy, while 55 patients underwent only laparoscopic cholecystectomy. The findings of the two groups were compared. Results: In the first group: pre-operative MRCP screening exposed clinically silent CBD stones in 2 patients (4.44%), while one patient (2.22%) had accessory cystic duct and another one had an abnormal insertion of cystic duct (2.22%). In the second group, 4 patients had postoperative complications (P < 0.05): residual stones, postoperative bile leak, jaundice and pancreatitis. Highlights:

show abstract

Assessment of Indicators for Predicting Choledocholithiasis Before Laparoscopic Cholecystectomy

Cited by 6 publications

References 18 publications

A scoring system for the prediction of choledocholithiasis: a prospective cohort study

A scoring system for the prediction of choledocholithiasis: a prospective cohort study

Biochemical and ultrasound parameters may help predict the need for therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in patients with a firm clinical and biochemical suspicion for choledocholithiasis

Does preoperative magnetic resonant cholangiopancreatography (MRCP), improve the safety of laparoscopic cholecystectomy?

Contact Info

Product

Resources

About