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

Current clinical algorithms for predicting common bile duct stones have only moderate accuracy

“…However, the main concern is the avoidance of ERCP procedures as a result of the associated complication risk and, thus, this study focused mainly on patients referred for ERCP, as did previous validation studies . Finally, although we attempted to obtain validity data on three commonly used algorithms for predicting CBD stones, there are other algorithms which were not assessed in the current report as they are more complex and/or they include biochemical data not routinely obtained in our institution (such as γ‐glutamyl transferase) that may be the subject of further validation studies in the future.…”

“…A risk‐stratified approach for selecting patients likely to harbor CBD stones to proceed directly to stone clearance rather than undergo less invasive testing, such as intraoperative cholangiography, endoscopic ultrasound (EUS), and magnetic resonance cholangiopancreatography (MRCP), has been suggested . Several risk‐stratification algorithms using predictors such as liver function tests (LFT), presence of cholangitis or pancreatitis, or findings on ultrasound (US) have been proposed .…”

Modern approach to cholecysto-choledocholithiasis

“…LCBDE was confirmed to be superior compared to open surgery in terms of mortality and morbidity (but less effective for common bile duct clearance) since 2006 [77] . Theoretically, LCBDE minimizes the risks of post-ERCP complications [26][27][28][29] and the need for further anesthesia, with an excellent success rate of stone extraction (more than 90%) [67,77] . However, LCBDE remains limited to centers with advanced laparoscopic expertise [12] .…”

“…Many of the diagnostic flow-charts and algorithms proposed consider a baseline stratification of the risk of having CBDS, including ultrasonography dilatation of the CBD and biochemical parameters, such as gammaglutamyl transpeptidase, transaminases, alkaline phosphatase, bilirubin and lactatedehydrogenase. All of these markers are combined in predictive models [16,29] to reserve more invasive or expensive imaging -cholangiography by ERCP or IOC, magnetic resonance cholangiography (MRC) and endoscopic ultrasonography (EUS) -for higher-risk patients, although no clinical-laboratory parameter is able to predict CBDS with optimal accuracy [30] . Currently, the most important preoperative diagnostic tools are MRC and the traditional ultrasound [31][32][33][34][35] .…”

Clinical presentations of patients from different age cohorts with biliary tract stone diseases

“…Endoscopic retrograde cholangiopancreatography (ERCP) has been the gold standard for the preoperative diagnosis of CBD stones and is a widely applied procedure for the diagnosis and treatment of these diseases . However, ERCP is also costly and associated with a substantial level of risk; thus, selection of patients with suspected CBD stones who are most likely to benefit from ERCP is important in proper treatment . The initial assessment of patients with suspected CBD stones should be based on clinical features, liver function tests (LFTs), and transabdominal ultrasound scan (USS) findings .…”