Risk assessment of choledocholithiasis prior to laparoscopic cholecystectomy and its management options

Aleknaite, Ausra; Simutis, Gintaras; Stanaitis, Juozas; Valantinas, Jonas; Strupas, Kęstutis

doi:10.1177/2050640617731262

Cited by 16 publications

(31 citation statements)

References 28 publications

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“…Prasiplėtęs BTL ir echoskopiškai jame matomi hiperechogeniniai dariniai keleto studijų apibūdinami kaip stipriausi TLA prediktoriai [19,[24][25][26][27].…”

Section: Echoskopijaunclassified

“…Septynių ASGE sistemą vertinančių studijų analizė parodė, kad suminės predikcinės didelės TLA rizikos vertės tėra patenkinamos: bendras jautrumas buvo 52,4 proc., specifiškumas -60,8 proc., teigiama prognostinė vertė -65,6 proc., neigiama prognostinė vertė -47,4 proc., tikslumas -55,9 proc. [24]. Perspektyviojo vertinimo rezultatai parodė, kad minėtų gairių naudojimas klinikinėje praktikoje gali lemti 20-30 proc.…”

Section: Tla Rizikos Vertinimo Sistemosunclassified

“…Neseniai atliktoje retrospektyvinėje studijoje įvertinti jo prognostiniai parametrai: indekso jautrumas -80,5 proc., specifiškumas -54,0 proc., tikslumas -71,1 proc. [24]. Šiuolaikiniai diagnostikos metodai leidžia mažiau invazyviai negu ERCP patikslinti įtariamus TL akme nis, todėl, remiantis retrospektyvine analize, šio indekso reikšmės buvo perskaičiuotos mažos, vidutinės ir didelės rizikos grupėms apibūdinti.…”

Section: Vilniaus Universiteto Ligoninės Tla Prognostinis Indeksasunclassified

“…Kelios studijos įrodė gana netikėtą teiginį, kad ūminis biliarinis pankreatitas nėra asocijuotas su TLA ar netgi gali būti laikomas kaip protekcinis, t. y. riziką TLA mažinantis veiksnys [21][22][23][24]. Tai leidžia pagrįsti hipotezę, kad biliarinis pankreatitas dažniau sukeliamas smulkių konkrementų, kurių spontaninė evakuacija iš BTL yra dažnesnė [21].…”

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Choledocholithiasis: when to Suspect, how to Diagnose, how to Treat

Aleknaite

Simutis

2019

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Bile duct stones are a quite common (10–18%) complication of gallstone disease or an autonomous condition. New noninvasive diagnostic methods established in the last decades allow to confirm suspected choledocholithiasis with minimal risk of iatrogenic complications.In this literature review we discuss various scores for choledocholithiasis risk degree, different diagnostic investigations and management approaches including timing for invasive procedures.

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“…Prasiplėtęs BTL ir echoskopiškai jame matomi hiperechogeniniai dariniai keleto studijų apibūdinami kaip stipriausi TLA prediktoriai [19,[24][25][26][27].…”

Section: Echoskopijaunclassified

Section: Tla Rizikos Vertinimo Sistemosunclassified

Section: Vilniaus Universiteto Ligoninės Tla Prognostinis Indeksasunclassified

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Choledocholithiasis: when to Suspect, how to Diagnose, how to Treat

Aleknaite

Simutis

2019

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“…Sample size was calculated in reference to collected data on management of choledocholithiasis in the trial centre, Vilnius University Hospital Santaros Klinikos (11). In our previous study mean treatment duration for different management strategy groups (LC-IOC first and ERCP-first) were 5.37 and 7.13 days, with standard deviations 2.5 and 2.8 respectively, these findings were used to calculate requested sample size.…”

Section: Statistical Considerationsmentioning

confidence: 99%

Comparison of Two Management Strategies, "Endoscopy First" and "Laparoscopic Cholecystectomy First", for Patients with Gallbladder Stones and Intermediate Risk for Choledocholithiasis: Study Protocol for a Randomized Trial

Aleknaite

Simutis

Stanaitis

et al. 2019

Preprint

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Background: The optimal approach for patients with gallbladder stones and intermediate risk for choledocholithiasis still remains undetermined. Use of diagnostic endoscopic retrograde cholangiopancreatography should be minimized as it carries considerable risk of post-procedural complications. This study compares two different management strategies: intraoperative cholangiography and endoscopic ultrasound before laparoscopic cholecystectomy for patients with symptomatic cholecystolithiasis and intermediate risk for choledocholithiasis. • Methods: It is a prospective randomized single-centre clinical trial enrolling adult patients undergoing laparoscopic cholecystectomy due to symptomatic gallbladder stones with intermediate risk for choledocholithiasis. The risk for choledocholithiasis is calculated using an original prognostic score – Vilnius University Hospital Index. A total of 106 participants will be included and randomized into two groups. Evaluation of bile ducts using endoscopic ultrasound and endoscopic retrograde cholangiography on demand will be performed before laparoscopic cholecystectomy for one arm (“Endoscopy first”). Intraoperative cholangiography during laparoscopic cholecystectomy and postoperative endoscopic retrograde cholangiopancreatography on demand will be administered in another arm (“Cholecystectomy first”). Postoperative follow-up is 6 months. The primary endpoint is the length of hospital stay. Secondary endpoints will include accuracy of the different management strategies, adverse events of interventions, duct clearance and technical success of interventions (intraoperative cholangiography, endoscopic ultrasound, endoscopic retrograde cholangiography), costs of treatment. • Discussion: This trial is planned determine which strategy is better approach for a patient with intermediate common bile duct stones risk and to define a simple to calculate and safe algorithm on managing choledocholithiasis. • Trial registration: The trial is registered at ClinicalTrials.gov, identification number NCT03658863.

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Destiny for Rendezvous: Is Cholecysto/Choledocholithiasis Better Treated with Dual- or Single-Step Procedures?

Vaccari

Minghetti²,

Lauro

et al. 2022

Dig Dis Sci

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Risk assessment of choledocholithiasis prior to laparoscopic cholecystectomy and its management options

Abstract: The prognostic index has good diagnostic accuracy but dividing patients into two risk groups is insufficient. The suggested model allows determining an intermediate-risk group, which requires additional investigation. Both management approaches are appropriate.

Cited by 16 publications

References 28 publications

Choledocholithiasis: when to Suspect, how to Diagnose, how to Treat

Choledocholithiasis: when to Suspect, how to Diagnose, how to Treat

Comparison of Two Management Strategies, "Endoscopy First" and "Laparoscopic Cholecystectomy First", for Patients with Gallbladder Stones and Intermediate Risk for Choledocholithiasis: Study Protocol for a Randomized Trial

Destiny for Rendezvous: Is Cholecysto/Choledocholithiasis Better Treated with Dual- or Single-Step Procedures?

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