Prediction of Common Bile Duct Stones by Noninvasive Tests

Abstract

ObjectiveTo define accurate and useful predictors of common bile duct stones (CBDS). Summary Background DataThe ability to predict CBDS with noninvasive tests can avoid unnecessary, costly, or risky procedures. MethodsAll patients referred for examination for CBDS by endoscopic ultrasonography (EUS) from 1993-1996 were prospectively entered in a database. In a first sample selected randomly from the whole population, predictors of CBDS were determined by univariate analysis and logistic regression. Predictors were subsequently tested in that sample and in the rest of the population. A separate analysis was done for patients planned for cholecystectomy. ResultsEight hundred and eighty patients (328 men, 552 women), aged 57.8 ± 17 years (range 16-94), were included. The prevalence of CBDS was 18.8%. Age, serum levels of bilirubin, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transferase (GGT), and alkaline phosphatase, and the existence of jaundice and fever, a dilated bile duct, and a pathologic gallbladder were found to be associated with CBDS. Logistic regression was undertaken separately for patients younger than 70 years (predictors: GGT >7xnormal; pathologic gallbladder; dilated bile duct) and older than 70 years (predictors: GGT >7xnormal; fever > 380C; dilated bile duct). Odds ratios were 3 to 6.7. The model was satisfactorily applicable to the second sample; age <70 years: x2 = 3.3 (NS); age >70 years: x2 = 3.8 (NS). In patients younger than age 70 and planned for cholecystectomy, the combination of the level of GGT and dilated bile duct predicted CBDS accurately. ConclusionsA simple screening of patients at risk for CBDS can be achieved with three predictive criteria adapted for the patient's age.

Acute transient hepatocellular injury in cholelithiasis and cholecystitis without evidence of choledocholithiasis

“…One setting in which there may be acute inflammation of the liver parenchyma is the presence of common bile duct (CBD) stones and cholangitis, situations in which liver tests have been widely studied [2][3][4] . We have found few investigations, however, of biochemical evidence of hepatocellular injury (hepatitis) in patients with cholelithiasis and cholecystitis who do not have CBD stones.…”

The value of magnetic resonance cholangiopancreatography for the exclusion of choledocholithiasis

“…[11,30] However, in studies assessing the predictive value of biochemical markers for CBD stones after logistic regression, the markers showing predictive value commonly vary. [11,[30][31][32] This inevitably undermines the results of any study attempting to identify these potential predictive factors.…”

Is it time to write obituary for open choledocholithotomy in the present era of endoscopic management? Outcome of surgery for failed endoscopic extraction, retrospective study

“…[1][2][3][4] Common bile duct (CBD) stones can be suspected pre-operatively by symptoms or signs of jaundice, pancreatitis, or cholangitis, or by derangement in liver function tests, or on imaging showing duct dilation or actual ductal stones. Treatment options include open cholecystectomy with open CBD exploration or laparoscopic cholecystectomy plus laparoscopic CBD exploration (LC + LCBDE) versus pre-or postcholecystectomy endoscopic retrograde cholangiopancreatography (ERCP) in two stages, usually combined with either sphincterotomy (commonest) or sphincteroplasty (papillary dilatation) for CBD clearance.…”