Preoperative predictors of choledocholithiasis in patients presenting with acute calculous cholecystitis

Chisholm, Phillip; Patel, Arpan; Law, Ryan; Schulman, Allison R.; BEDI, A; Kwon, Richard S.; Wamsteker, Erik; Anderson, Michelle A.; Elta, Grace H.; Govani, Shail M.; Prabhu, Anoop

doi:10.1016/j.gie.2018.11.017

Cited by 38 publications

(58 citation statements)

References 30 publications

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“…The current management algorithm and risk stratification have been mainly driven by the American Society of Gastroenterology recommendations. Recent studies have shown that these recommendations contribute to a delay in reaching definitive management, which increases costs because of referral for unnecessary imaging [10].…”

Section: Discussionmentioning

confidence: 99%

“…Chisholm et al [10] have suggested an internally validate new risk stratification according to mainly three predictors which are: any elevated alkaline phosphatase, common bile duct diameter greater than 6 mm, and ALT elevation three times greater than the normal level.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with all three risk factors (high risk for CDL, approximately 10% of the validation cohort) had negative ERCP 22% of the time. On the other hand, applying current ASGE guidelines to the same cohort showed a negative ERCP proportion of 42.4%, and it also showed that 62.6% of the patients would be referred for further testing despite not having CDL [10].…”

Section: Introductionmentioning

confidence: 92%

“…Chisholm et al recently published a novel module that included new predictors along with a new management algorithm [10]. The new module included three predictors, a common bile duct diameter larger than 6 mm, alkaline phosphatase (ALP) above the normal range, and alanine aminotransferase (ALT) greater than three times the normal level.…”

Section: Introductionmentioning

confidence: 99%

“…The new management algorithm suggested that patients in the high-risk group can be referred directly to ERCP without further imaging or delay, while patients in the moderate-risk category should undergo further imaging to decide the management plan. On the other hand, patients in the low-risk group can proceed to cholecystectomy with no need for further imaging or ERCP [10].…”

Section: Introductionmentioning

confidence: 99%

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Pre-Operative Predictors of Concurrent Choledocholithiasis in Patients With Acute Calculus Cholecystitis: An External Validity Analysis

Affas

Chaar

Zamora-Sifuentes

et al. 2020

Cureus

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Introduction Patients that are presented with acute calculus cholecystitis (AC) and elevated liver enzymes markers (LEM), often require evaluation for concurrent choledocholithiasis (CDL). Currently, evaluation guidelines follow the American Society of Gastroenterology Endoscopy (ASGE) recommendations. Objectives The aim of the study was to externally validate both ASGE and the Chisholm predictors in a community hospital patient cohort. Methods We conducted a retrospective study of patients who presented to Ascension Saint John hospital with AC and elevated LEM over a period of two years. Sensitivity (SEN), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) were used to test the external validity of ASGE and Chisholm algorithms. Results A total of 132 patients' charts were reviewed, and 87 patients included. Chisholm predictors SEN, SP, PPV and NPV were 50%, 82%, 18%, and 95% respectively versus 100%, 19%, 8%, 100% for the ASGE predictors model. In the ASGE module, SP and PPV can be significantly improved to 60% and 13%, respectively, by changing a few risk categories including age and LEM range. Conclusions External validation of the Chisholm module in our patient cohort showed that it would lead to a low referral rate for unnecessary imaging and thus might be more cost-effective, especially when compared to current ASGE recommendations which would have a higher referral rate. On the other hand, current ASGE recommendations successively labeled all the patients with CDL, while the Chisholm module missed around 50 percent. We also observed that with the current ASGE module, the referral rate for further imaging and diagnostic tests can be possibly improved by adjusting a few of the predictors including the age and the abnormal liver transaminases range, but this observation is arbitrary and will need to be validated in a larger cohort study.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Pre-Operative Predictors of Concurrent Choledocholithiasis in Patients With Acute Calculus Cholecystitis: An External Validity Analysis

Affas

Chaar

Zamora-Sifuentes

et al. 2020

Cureus

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ERCP Peri‐Cholecystectomy

Tarnasky¹

2020

Ercp

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Standardizing process in acute biliary disease

Tranter‐Entwistle,

Eglinton,

Connor

2023

World j. surg.

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IntroductionThe perioperative management of biliary disease (BD) is variable across institutions with suboptimal outcomes for patients and health care systems. This results in inefficient utilization of limited resources. The aim of the current study was to identify modifiable factors impacting patients' time to theater, intraoperative time, and time to discharge as the constituents of length of stay to guide creation of a perioperative management protocol to address this variability.MethodsData were prospectively captured at Christchurch Hospital for all adult patients presenting for cholecystectomy between May 2015 and May 2022. Pre, post, and intraoperative factors were assessed for their impact on time to theater, operative time, and postoperative hours to discharge.ResultsFour thousand five hundred seventy‐seven patients underwent cholecystectomy during the study period, of which 2807 (61%) were acute presentations and made up the cohort for analysis. Time to theater was significantly impacted by preoperative imaging type, while operative grade and the procedure type had the most clinically significant impact on operative time. Postoperatively time to discharge was significantly impacted by drain placement.ConclusionsStandardizing management of BD would likely result in significant savings for the health care system and improved outcomes for patients. The data seen here evidence the importance of appropriate imaging selection, intraoperative difficulty operative grade identification, and low suction drain selection. These data have been incorporated in a perioperative management protocol as standardization of care across the patient workflow in BD is a sensible approach for ensuring optimal use of scarce resources.

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Preoperative predictors of choledocholithiasis in patients presenting with acute calculous cholecystitis

Cited by 38 publications

References 30 publications

Pre-Operative Predictors of Concurrent Choledocholithiasis in Patients With Acute Calculus Cholecystitis: An External Validity Analysis

Pre-Operative Predictors of Concurrent Choledocholithiasis in Patients With Acute Calculus Cholecystitis: An External Validity Analysis

ERCP Peri‐Cholecystectomy

Standardizing process in acute biliary disease

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