Validation and improvement of a proposed scoring system to detect retained common bile duct stones in gallstone pancreatitis

Sherman, Jingjing; Shi, Emily W.; Ranasinghe, Nalin E.; Sivasankaran, Muthu T.; Prigoff, Jake G.; Divino, Celia M.

doi:10.1016/j.surg.2015.01.005

Cited by 29 publications

(15 citation statements)

References 19 publications

(22 reference statements)

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“…The presence or absence of CBDS can be predicted to some extent using preoperative criteria, but these fail to reach 100% accuracy[ 64 , 65 ]. Catheline et al[ 20 ], in a retrospective trial published in 1999, reported a perioperative CBDS detection rate of 9%.…”

Section: Resultsmentioning

confidence: 99%

Laparoscopic ultrasonography as an alternative to intraoperative cholangiography during laparoscopic cholecystectomy

Dili

Bertrand

2017

WJG

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AIMTo assess the role of laparoscopic ultrasound (LUS) as a substitute for intraoperative cholangiography (IOC) during cholecystectomy.METHODSWe present a MEDLINE and PubMed literature search, having used the key-words “laparoscopic intraoperative ultrasound” and “laparoscopic cholecystectomy”. All relevant English language publications from 2000 to 2016 were identified, with data extracted for the role of LUS in the anatomical delineation of the biliary tract, detection of common bile duct stones (CBDS), prevention or early detection of biliary duct injury (BDI), and incidental findings during laparoscopic cholecystectomy. Data for the role of LUS vs IOC in complex situations (i.e., inflammatory disease/fibrosis) were specifically analyzed.RESULTSWe report data from eighteen reports, 13 prospective non-randomized trials, 5 retrospective trials, and two meta-analyses assessing diagnostic accuracy, with one analysis also assessing costs, duration of the examination, and anatomical mapping. Overall, LUS was shown to provide highly sensitive mapping of the extra-pancreatic biliary anatomy in 92%-100% of patients, with more difficulty encountered in delineation of the intra-pancreatic segment of the biliary tract (73.8%-98%). Identification of vascular and biliary variations has been documented in two studies. Although inflammatory disease hampered accuracy, LUS was still advantageous vs IOC in patients with obscured anatomy. LUS can be performed before any dissection and repeated at will to guide the surgeon especially when hilar mapping is difficult due to fibrosis and inflammation. In two studies LUS prevented conversion in 91% of patients with difficult scenarios. Considering CBDS detection, LUS sensitivity and specificity were 76%-100% and 96.2%-100%, respectively. LUS allowed the diagnosis/treatment of incidental findings of adjacent organs. No valuable data for BDI prevention or detection could be retrieved, even if no BDI was documented in the reports analyzed. Literature analysis proved LUS as a safe, quick, non-irradiating, cost-effective technique, which is comparatively well known although largely under-utilized, probably due to the perception of a difficult learning curve.CONCLUSIONWe highlight the advantages and limitations of laparoscopic ultrasound during cholecystectomy, and underline its value in difficult scenarios when the anatomy is obscured.

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Section: Resultsmentioning

confidence: 99%

Laparoscopic ultrasonography as an alternative to intraoperative cholangiography during laparoscopic cholecystectomy

Dili

Bertrand

2017

WJG

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“…Several studies have evaluated the predictive power of biochemical and imaging parameters and their combinations, 13 – 16 although there is still no validated scoring system. 17 , 18 In the present study, we developed and validated a scoring system that uses simple laboratory and imaging parameters, and recommend a systematic approach that uses ERCP only when it is essential.…”

Section: Discussionmentioning

confidence: 98%

A scoring system for the prediction of choledocholithiasis: a prospective cohort study

Al-Jiffry

Khayat²,

Abdeen³

et al. 2016

Annals of Saudi Medicine

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BACKGROUNDTechniques for diagnosing choledocholithiasis pose significant morbidity and mortality risks.OBJECTIVESWe aimed to develop and validate a clinical scoring system for predicting choledocholithiasis.DESIGNData from a prospectively maintained database of all patients with gallstones.SETTINGPatients were admitted to the general surgery department of a military hospital.PATIENTS AND METHODSWe enrolled consecutive patients with symptomatic gallstones, biliary pancreatitis, obstructive jaundice, or cholangitis, who subsequently underwent biochemical testing and ultrasonography. A predictive model was developed from a scoring system using their imaging and laboratory data. Endoscopic retrograde cholangiopancreatography (ERCP) or intraoperative cholangiography were used for confirmatory diagnoses. The predictive efficacy of the scoring system was validated using a retrospective cohort of 272 patients.MAIN OUTCOME MEASURESPredictive accuracy of the scoring system.RESULTSWe enrolled 155 patients in the development group. The common bile duct diameter, alkaline phosphatase of ≥200 IU, elevated bilirubin levels, alanine transaminase of ≥220 IU, and male age of ≥50 years were significantly associated with choledocholithiasis and were included in the scoring system. Ninety-six patients (35%) had scores of ≥8 (high risk), 86 patients (32%) had scores of 4–7 (intermediate risk), and 27 patients (10%) had scores of 1–3 (low risk). In the validation cohort, the positive predictive value for a score of ≥8 was 91.7%, and the scoring system had an area under the curve of 0.896.CONCLUSIONScores of ≥8 were strongly correlated with choledocholithiasis in the developmental and validation groups, which indicates that our scoring system may be useful for predicting the need for therapeutic ERCP. However, prospective validation in a large multicenter cohort is needed to fully understand the benefits of the system.LIMITATIONSThe retrospective validation cohort might have introduced selection and observational biases. The study may have been underpowered because of the sample size of the developmental cohort. The delay between admission and the time of ERCP theoretically may have increased the number of negative ERCP results, but our false negative rate for ERCP was consistent with the previously reported rates.

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“…Pradėjus plačiai taikyti ERCP, atsirado poreikis nustatyti atvejus, kada procedūra reikalinga. Yra nemažai modelių ar vertinimo sistemų TLA tikimybei apskaičiuoti, dauguma jų remiasi klinikiniais, biocheminiais ir ultragarso duomenimis [28][29][30][31][32][33][34][35][36][37]. TLA vertinimo sistemų reziumė pateikta 1 lentelėje.…”

Section: Tla Rizikos Vertinimo Sistemosunclassified

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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Validation and improvement of a proposed scoring system to detect retained common bile duct stones in gallstone pancreatitis

Cited by 29 publications

References 19 publications

Laparoscopic ultrasonography as an alternative to intraoperative cholangiography during laparoscopic cholecystectomy

Laparoscopic ultrasonography as an alternative to intraoperative cholangiography during laparoscopic cholecystectomy

A scoring system for the prediction of choledocholithiasis: a prospective cohort study

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

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