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>Journals >Cirujano General >Year 2007, Issue 1


Lagunes GA, Sánchez LR
Preoperative predictive factors in choledocholithiasis. Experience at the General Hospital of Mexico
Cir Gen 2007; 29 (1)

Language: Español
References: 21
Page: 22-26
PDF: 4. Kb.


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ABSTRACT

Objective: To identify the most accurate clinical, biochemical, and ultrasound parameters to predict the risk of choledocholithiasis in patients with cholelithiasis and avoid unnecessary endoscopic retrograde cholangiopancreatography (ERCP).
Setting: Third level health care hospital.
Design: Retrospective, comparative and observational study.
Statistical analysis: Dispersion and central tendency measures. Sensitivity, specificity, positive and negative predictive values.
Material and methods: We assessed the parameters indicative of the need for ERCP in patients with choledocholithiasis during one year. Assessed variables were: gender, age, jaundice and time of evolution, acholia, choluria, fever pruritus, biliary colic, and pancreatitis antecedents. Biochemical variables were: total and direct bilirubin, alkaline phosphatase, glutamic-oxaloacetic transaminase, glutamic-pyruvic transaminase, lipase and leukocytes. The ultrasound study included: determination of choledocholithiasis and choledochal diameter. We also evaluated resolution obtained with ERCP and its morbidity and mortality.
Results: We included 69 patients for ERCP. In 55%, the choledocholithiasis diagnosis was confirmed and, in 61% of these, ERCP was resolutive, with a morbidity of 21%. After ERCP, 53 patients were subjected to cholecystectomy; 23% through laparoscopy and 77% with open surgery. The preoperative parameter with the best diagnostic value was jaundice (negative predictive value, 100%), followed by elevated seric bilirubin, and choledochus dilation as assessed by ultrasound. The least sensitive parameter was the antecedent of pancreatitis, However, no parameter had a diagnostic value, for both sensitivity and specificity, above 90%.
Conclusion: The assessed clinical, biochemical, and ultrasound parameters did not have sufficient clinical value to detect accurately the risk of choledocholithiasis in patients with cholelithiasis and, consequently, cannot be used to decrease unnecessary ERCP.


Key words: Choledocholithiasis, preoperative evaluation, ERCP.


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