Intermediate Risk of Choledocholithiasis: Are we on the right path?

Abstract

BackgroundRisk of choledocholithiasis should be assessed in every patient who must undergo cholecystectomy to define the next step. American Society for Gastrointestinal endoscopy (ASGE) proposed a stratified predictor scale of choledocholithiasis. MethodsTo describe our experience managing patients with intermediate risk of choledocholithiasis according to the ASGE guidelines and actual presence of bile duct stones in magnetic resonance cholangiopancreatography. A retrospective observational study with a prospective database was conducted. Analysis included socio demographic data, laboratory values ​​and imaging. Bivariate, multivariate and ROC analysis was performed. Results 327 patients had intermediate risk for choledocholithiasis. Half the patients were at least 65 years old. 24.8% were diagnosed with choledocholithiasis. Bile duct dilation was documented in only 3.06% of cases. Diagnosis of choledocholithiasis is associated with age OR: 1.87 (p 0.02), alkaline phosphatase OR: 2.44 (p 0.02) and bile duct dilation > 6 mm OR: 14.65 (p 0.00). ConclusionsHigh variability in accuracy of imaging techniques results in a large number of patients classified as intermediate risk without choledocholithiasis in cholangio-resonance. Therefore, enhancing the criteria to define intermediate risk for patients in order to optimize resources is of paramount importance.