Endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis: From guidelines to clinical practice

Magalhães, Joana

doi:10.4253/wjge.v7.i2.128

Cited by 55 publications

(68 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A similar finding was made for the intermediate risk score, where both the sensitivity and positive predictive value in our series were lower than those described in published series on patients with suspected choledocholithiasis (14.4 and 41%, respectively) [9][10][11][12] .…”

Section: Discussioncontrasting

confidence: 46%

“…While the sensitivity of the high risk score was approximately the same as found in published series in patients with suspected choledocholithiasis overall (86%), the positive predictive value was significantly lower (52 vs. 71-79%) [9][10][11][12] . A similar finding was made for the intermediate risk score, where both the sensitivity and positive predictive value in our series were lower than those described in published series on patients with suspected choledocholithiasis (14.4 and 41%, respectively) [9][10][11][12] .…”

Section: Discussionmentioning

confidence: 63%

See 1 more Smart Citation

Performance of the Choledocholithiasis Diagnostic Score in Patients with Acute Cholecystitis

Gouveia

Loureiro

Ferreira

et al. 2017

GE Port J Gastroenterol

View full text Add to dashboard Cite

Introduction: The prevalence of choledocholithiasis among patients with acute cholecystitis is estimated to be between 9 and 16.5%. There are no validated algorithms to predict choledocholithiasis in this group of patients. Aim: The aim of this study was to evaluate the performance of the choledocholithiasis diagnostic score proposed by the American Society for Gastrointestinal Endoscopy, in patients with acute cholecystitis. Material/Methods: A retrospective cross-sectional study, covering a 4-year period at a secondary care hospital, was performed. All patients with an encoded diagnosis of acute cholecystitis and with at least one of the following procedures were included: endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound, magnetic resonance cholangiopancreatography, and intraoperative cholangiography. Results: Among 4,369 patients with the diagnosis of acute cholecystitis, 40 (0.92%) had clinical or sonographic suspicion of choledocholithiasis. Their mean age was 68.1 ± 15 years, and 22 (55%) were men. Thirty-one of the patients included (77.5%) had a high risk of choledocholithiasis, and 9 (22.5%) had an intermediate risk. In 16 (51.6%) of the 31 patients with a high risk, the diagnosis of choledocholithiasis was confirmed. In 2 (22.2%) of the 9 patients with an intermediate risk, the diagnosis of choledocholithiasis was also confirmed. The high risk score for choledocholithiasis had a positive predictive value of 52% and a sensitivity of 89%. The intermediate risk score for choledocholithiasis had a positive predictive value of 22% and a sensitivity of 11%. Discussion and Conclusions: Suspicion of choledocholithiasis in patients with acute cholecystitis was a rare event (<1%). The sensitivity of the high risk score was approximately the same as found in published series with patients with suspected choledocholithiasis overall (86%), while the positive predictive value was substantially lower (52 vs. 79.8%). Therefore, in patients with acute cholecystitis and suspected choledocholithiasis, this score should not be used to screen for common bile duct stones, and a sensitive method should be used prior to ERCP.

show abstract

Section: Discussioncontrasting

confidence: 46%

Section: Discussionmentioning

confidence: 63%

Performance of the Choledocholithiasis Diagnostic Score in Patients with Acute Cholecystitis

Gouveia

Loureiro

Ferreira

et al. 2017

GE Port J Gastroenterol

View full text Add to dashboard Cite

show abstract

“…7,9,10 Al constituirse en una patología biliar de presentación atípica, recae un valor agregado el diagnóstico oportuno, para evitar el advenimiento de diversas complicaciones. 11 Es así, que la colangiorresonancia magnética se constituye en un auxiliar fundamental para visualizar el terreno en donde vamos a llevar a cabo nuestras acciones terapéuticas, con la colangiograf{ia retrógrada endoscópica como auxiliar terapéutico añadido; 12,13,16 y en cuanto al tratamiento, se demuestra que la técnica elegida fue la que menos efectos de morbimortalidad presentaba, siendo la anastomosis del colédoco al duodeno en este caso muy superior a la hepatoyeyuno anastomosis en Y de Roux por cuanto los signos de colangitis resultantes son mucho más lesivos en la segunda técnica que en la primera.…”

Section: Discussionunclassified

“…6 Para el enfrentamiento de la misma es importante conocer la ubicación, número, estado general del paciente, impactación y tamaño del cálculo; siendo el último factor una entidad clínica independiente. 7 Se considera que cuando el diámetro del lito es superior o igual a 15-20 mm, se lo denomina megalitiasis. 7 La historia clínica, exámenes de laboratorio, estudios de imagenología como ecografía, resonancia magnética nuclear, métodos diagnósticos invasivos como la colangiografia retrógrada con papilotomía, son herramientas de gran utilidad para saber cuál es la actitud más adecuada a seguir en el tratamiento de la coledocolitiasis, 8,9,10,11 más aun cuando se ha reportado fracasos en el tratamiento endoscópico con tasas de hasta el 88 % 12,13,14 y particularmente en los casos de coledocolitiasis con cálculos de gran tamaño.…”

Section: Introductionunclassified

Megalitiasis de la vía biliar intra y extrahepática. Presentación atípica. Informe de un caso

et al. 2017

View full text Add to dashboard Cite

ResumenLas vías biliares intra y extrahepáticas suelen ser un lugar de formación de cálculos de diverso tamaño, pero se han descrito casos aislados de megalitiasis. El objetivo es presentar un caso clínico, cuadro biliar, sin evidencia clínica de colestasis, secundario a litiasis gigante intra y extrahepáticas; se realiza una revisión bibliográfica. Caso clínico de varón de 59 años, con patología cardiaca concomitante, que presenta cuadro de varios días de evolución, caracterizado por dolor abdominal de tipo cólico en hipocondrio derecho, sin signos de colestasis, sin ictericia, sin náuseas, pero con deterioro del sensorio. Pruebas específicas para vías biliares alteradas, con hiperbilirrubinemia, colangiorresonancia revela litiasis de gran tamaño, colangiografía retrógrada reveló vías biliares intra y extrahepáticas dilatadas, se realizó esfinterotomía endoscópica y evacuación de ductos biliares de manera parcial, por lo que se procedió a acto quirúrgico mediante colecistectomía, coledocotomía y anastomosis del colédoco al duodeno, con resolución del cuadro. Se concluye que la megalitiasis, es de presentación atípica. Las caracteristicas de esta entidad, revelan un espectro diferente de manifestaciones tanto clínicas como de laboratorio.PALABRAS CLAVE: cálculos biliares, cálculos, megalitiasis, esfinterotomía endoscópica. Abstract Intrahepatic and extrahepatic bile ducts are often places of formation of calculi of several sizes, but isolated cases of megalithiasis have been described. The objective is to present a clinical case, a biliary table, without clinical evidence of cholestasis, secondary to the intro and extrahepatic giant lithiasis, a bibliographic review is made. A 59-year-old male patient with concomitant cardiac pathology, with a condition of several days of evolution, characterized by cramping abdominal pain in the right hypochondrium, without signs of cholestasis, without jaundice, without nausea, but with deterioration of the sensorium. Specific tests for altered biliary tract, with hyperbilirubinemia, cholangiorresonance reveals large lithiasis, retrograde cholangiography revealed dilated intro and extrahepatic biliary tract, endoscopic sphincterotomy was performed and partial bile duct evacuation, so a surgical procedure was performed by cholecystectomy, choledochotomy and anastomosis of the common bile duct to the duodenum, with resolution of the condition. It is concluded that megalithiasis is atypical. The characteristics of this entity reveal a different spectrum of clinical and laboratory manifestations.KEYWORDS: gallstones, calculi, megalithiasis, sphincterotomy, endoscopic.Resumo Os ductos biliares intra e extra-hepáticos são geralmente um lugar de formação de pedra de tamanho diferente, mas relatos isolados de megalitiasis tem se descrito. O objetivo é apresentar um caso de ductos biliares sem evidência clínica de colestase, secundaria a litiase gigante intra-hepática e extra-hepática, foi realizada uma revisão da literatura. Caso clínico de um homem de 59 anos, com patologia cardíaca ...

show abstract

“…In Europe, ultrasound studies revealed a prevalence of 9-21% and an incidence of 0.63/100 persons/year [1][2][3][4] . Choledocholithiasis or common bile duct (CBD) stones are a frequent complication of gallstone disease and are pres-stones [4] .…”

mentioning

confidence: 99%

Once upon a Time a Guideline Was Used for the Evaluation of Suspected Choledocholithiasis: A Fairy Tale or a Nightmare

Canena¹

2017

GE Port J Gastroenterol

View full text Add to dashboard Cite

Endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis: From guidelines to clinical practice

Abstract: 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.

Cited by 55 publications

References 26 publications

Performance of the Choledocholithiasis Diagnostic Score in Patients with Acute Cholecystitis

Performance of the Choledocholithiasis Diagnostic Score in Patients with Acute Cholecystitis

Megalitiasis de la vía biliar intra y extrahepática. Presentación atípica. Informe de un caso

Once upon a Time a Guideline Was Used for the Evaluation of Suspected Choledocholithiasis: A Fairy Tale or a Nightmare

Contact Info

Product

Resources

About