Design of a preoperative predictive score for choledocholithiasis

Autores de IIS La Fe

• José Bueno Lledó

  Autor

• Rafael López Andújar

  Autor

Participantes ajenos a IIS La Fe

• Ibáñez Cirión JL
• Torregrosa Gallud A

Grupos

• Hepatología experimental y Trasplante hepático

Abstract

Introduction: Choledocholithiasis is the most common cause of obstructive jaundice and occurs in 5-10% of patients with cholelithiasis. Objectives: To design a preoperative predictive score for choledocholithiasis. Material and methods: A prospective study was carried out in 556 patients admitted to our department for biliary disease. Preoperative clinical, laboratory, and ultrasound variables were compared between patients without choledocholithiasis and 65 patients with this diagnosis. A multivariate logistic analysis was performed to obtain a predictive model of choledocholithiasis, determining sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: Predictors of choledocholithiasis were the presence of a prior history of biliary disease (history of biliary colic, acute cholecystitis, choledocholithiasis or acute biliary pancreatitis) (p = 0.021, OR = 2.225, 95% CI: 1.130-4.381), total bilirubin values >4 mg/dl (p = 0.046, OR = 2.403, 95% CI: 1.106-5.685), alkaline phosphatase values > 150 mg/dl (p = 0.022 income, OR = 2.631, 95%: 1.386-6.231), gamma-glutamyltransferase (GGT) values > 100 mg/dl. (p = 0.035, OR = 2.10, 95% CI: 1.345-5.850), and an ultrasound finding of biliary duct > 8 mm (p = 0.034, OR = 3.063 95% CI: 1086-8649). A score superior to 5 had a specificity and PPV of 100% for detecting choledocholithiasis and a score less than 3 had a sensitivity and NPV of 100% for excluding this diagnosis. Conclusions: The preoperative score can exclude or confirm the presence of choledocholithiasis and allows patients to directly benefit from laparoscopic cholecystectomy (LC) or prior endoscopic retrograde cholangiopancreatography (ERCP). (C) 2014 Elsevier Espana, S.L.U. and AEEH y AEG. All rights reserved.

Keywords

• Choledocholithiasis; Cholelithiasis; Predictive score; Laparoscopic cholecystectomy