Utility of the “BATS” Score in Predicting Choledocholithiasis in Patients With Gall Bladder Stones

Abstract

Background and aim The role of expensive, risky, and unnecessary endoscopic interventions can be avoided by the use of non-invasive tests to predict common bile duct (CBD) stones. Therefore, our aim was to identify non-invasive predictors of choledocholithiasis (CL) in patients and further to predict a model and assess its diagnostic accuracy in predicting CL. Methods This cross-sectional study was carried out from June 1, 2020, to December 31, 2021. Patients having gall bladder stones on percutaneous transabdominal sonography and fulfilling intermediate probability criteria of CL were enrolled. These patients then underwent radial endoscopic ultrasound (EUS) followed by endoscopic retrograde cholangiopancreatography (ERCP) for detecting CBD stones. Univariate logistic regression analysis, followed by multivariate logistic regression analysis, was performed to ascertain the independent predictors of CBD stone in patients with intermediate probability. A model was proposed, and the diagnostic accuracy was calculated at an optimal cutoff. The model was then internally validated in the patients with intermediate probability and was also compared with the pre-existing score. Results Out of 131 patients included in the study, CBD stone was noted in 85 (66%) and 88 (67.2%) patients on EUS and ERCP, respectively. On multivariate analysis, high serum bilirubin (>2 mg/dL) and alkaline phosphatase (200 IU) and dilated CBD (>6 mm) on transabdominal sonography at baseline were significant predictors of CBD stone in these patients. Using these variables, a scoring system (BATS score) was developed, which had an area under the receiver operating curve (AUROC) of 0.98 in predicting the presence of CBD stone with a sensitivity of 93.18%, a specificity of 76.74%, and a diagnostic accuracy of 87.79%. In the validation cohort, a BATS score of ≥5 had a diagnostic accuracy of 95.91% in predicting CL. Conclusion The BATS score showed excellent sensitivity and good diagnostic accuracy in predicting the CBD stone with excellent results on internal validation. However, external validation of our results is required to recommend this model on a larger scale.

Development and validation of a predictive model for choledocholithiasis

“…5,6 Various prognostic scales, models, and algorithms have emerged to predict the probability of choledocholithiasis. [7][8][9][10][11][12] Our principal aim was to assess factors associated with CBD stones in patients exhibiting symptoms of gallstones, biliary pancreatitis, obstructive jaundice, or cholangitis. Our subsequent goal was to employ these identified factors to formulate and validate a predictive model for choledocholithiasis.…”

“…The existing guidelines established by the American Society for Gastrointestinal Endoscopy (ASGE) in 2010, 3 while based on clinical, biochemical, and radiological parameters, possess radical cutoff points and broad probability ranges, resulting in lower diagnostic precision and sometimes prompting excessive use of invasive procedures like endoscopic retrograde cholangiopancreatography (ERCP) and its associated complications 5,6 . Various prognostic scales, models, and algorithms have emerged to predict the probability of choledocholithiasis 7–12 …”