Predictive factors for synchronous common bile duct stones in patients with cholelithiasis

Alponat, Ahmet; Kum, C. K.; Rajnakova, Andrea; Koh, Bee Choo; Goh, P. M. Y.

doi:10.1007/s004649900489

Cited by 52 publications

(46 citation statements)

References 21 publications

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“…Diagnosis of common bile duct stones diagnosed. Higher NPV means then higher sensitivity for excluding CBDS as shown in our study; combining several tests in our study increased the negative predictive value and sensitivity of CBDS exclusion with almost equal specificity [16][17][18]30] . We concluded that patients with normal ultrasonography, LFT results and no clinical evidence of CBDS "negative triple test" (NPV of 97.3%) may undergo laparoscopic surgery without any need for preoperative MRCP or ERCP.…”

Section: Discussionsupporting

confidence: 74%

“…There is thus a need for easy-performing, non-invasive, and reliable test modalities to diagnose or exclude CBDS, by which selected patients can benefit from ERCP, MRCP or other expensive investigations [13][14][15] . Earlier studies on some clinical, laboratory or radiological variables have been performed [16,17] . There is however, as far as we know, no study performed evaluating a combination of these investigating modalities.…”

Section: Discussionmentioning

confidence: 99%

“…A focused positive patient's history may be an early indication of CBDS [3,6,[16][17][18] . Hyperbilirubinemia preoperatively, had a high diagnostic significant in our study and is also reported by others [7,19] .…”

Section: Discussionmentioning

confidence: 99%

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Triple non-invasive diagnostic test for exclusion of common bile ducts stones before laparoscopic cholecystectomy

Pourseidi

Khorram‐Manesh

2007

WJG

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AIM:To evaluate the impact of a preoperative "triple non-invasive diagnostic test" for diagnosis and/or exclusion of common bile duct stones. METHODS:All patients with symptomatic gallstone disease, operated on by laparoscopic cholecystectomy f r o m M a r c h 2 0 0 4 t o M a r c h 2 0 0 6 w e r e s t u d i e d retrospectively. Two hundred patients were included and reviewed by using a triple diagnostic test including: patient's medical history, routine liver function tests and routine ultrasonography. All patients were followed up 2-24 mo after surgery to evaluate the impact of triple diagnostic test.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

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Triple non-invasive diagnostic test for exclusion of common bile ducts stones before laparoscopic cholecystectomy

Pourseidi

Khorram‐Manesh

2007

WJG

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“…Clinical, ultrasonographic, and serum chemistry data commonly acquired during patient evaluations are sensitive in 96% to 98% and specific in 40% to 75% of the patients for the determination of choledocholithiasis. [2][3][4] Therefore, when these indicators are used for the selection of patients for endoscopic retrograde cholangiopancreatography (ERCP), up to 75% of the patients have no common bile duct (CBD) stones found during the procedure. Even though ERCP is effective for the diagnosis and clearance of CBD stones, this procedure can be associated with patient discomfort, inconvenience, and complications.…”

Section: Discussionmentioning

confidence: 99%

“…1 Choledocholithiasis is detected in 8% to 20% of patients undergoing cholecystectomy. [2][3][4] Several options are available for the diagnosis and treatment of choledocholithiasis, but there is no consensus on the optimal management strategy for these patients. 5 The selection of diagnostic and treatment approaches depends on multiple factors, including the level of suspicion for choledocholithiasis, patient and physician preferences, resource availability, and the expertise of the surgeons, endoscopists, and radiologists.…”

Section: Discussionmentioning

confidence: 99%

Patient Evaluation and Management With Selective Use of Magnetic Resonance Cholangiography and Endoscopic Retrograde Cholangiopancreatography Before Laparoscopic Cholecystectomy

Liu¹,

Consorti²,

Kawashima³

et al. 2001

Annals of Surgery

110

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Small Gallstones and Pancreatitis *

et al. 2005

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We found the article by Venneman and coworkers 1 of great interest. In the effort to identify the potential risk factors for patients with gallbladder stones (GBSs) to develop pancreatitis, they consider several clinical, histopathological, biochemical, and ultrasonographic parameters, finding only three (GBS size, gallbladder motility, and rapidity of cholesterol crystallization) to be related to pancreatitis.The results of Venneman and colleagues confirm the evidence of biliary pancreatitis as the final stage of a sequence of events starting with cholelithiasis, continuing with the migration of stones, and finally leading to pancreatitis. According to this model, the smaller the stones, the faster the emptying of the gallbladder and the greater the risk of developing pancreatitis. On the basis of their findings, the authors propose that patients with asymptomatic small GBSs and/or preserved motility of the gallbladder undergo prophylactic cholecystectomy. However, in our opinion, there are some clinical issues that must be addressed.The authors compare patients who already had pancreatitis and patients having symptomatic GBSs. In our opinion, the finding of parameters significantly related to pancreatitis has no impact on the therapeutic strategy, because all of these patients are candidates per se for prophylactic cholecystectomy. Significantly, the authors propose, despite Gracie and Ransohoff's recommendations for asymptomatic patients, 2 to select patients for cholecystectomy in the absence of symptoms, yet this category of patients was not included in the study.In this perspective, because biliary symptoms are also generally accepted as increasing the risk of complications, it may be argued that the contemporary presence of Venneman and colleagues' criteria (small gallstones and/or preserved gallbladder motility) and biliary symptoms defines a class of patients at even higher risk of developing pancreatitis, for which an urgent (or early) rather than elective scheduling of cholecystectomy could be recommended. Obviously, only prospective, randomized studies may confirm these hypotheses and define the lines of treatment.We, too, believe that the most interesting question is: Is it possible to select for surgery asymptomatic patients who would otherwise not be cholecystectomized and who will finally develop complications? Recently, we 3 and other authors 4-7 elaborated scoring systems to quantify the risk of GBSs migrating to the common bile duct. In our opinion, these scoring systems could be useful in selecting patients at risk for complication.Venneman and colleagues propose two criteria (gallbladder motility, GBS size) for the selection of patients to undergo cholecystectomy. Whereas the assessment of gallbladder motility is accomplished via ultrasonography, it is unclear how to preoperatively assess the size of GBSs, which are accurately measured after washing, drying and counting, obviously after gallbladder extirpation.We found that (1) the risk of migration of GBSs is greater when they are small and ...

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Predictive factors for synchronous common bile duct stones in patients with cholelithiasis

Cited by 52 publications

References 21 publications

Triple non-invasive diagnostic test for exclusion of common bile ducts stones before laparoscopic cholecystectomy

Triple non-invasive diagnostic test for exclusion of common bile ducts stones before laparoscopic cholecystectomy

Patient Evaluation and Management With Selective Use of Magnetic Resonance Cholangiography and Endoscopic Retrograde Cholangiopancreatography Before Laparoscopic Cholecystectomy

Small Gallstones and Pancreatitis *

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