>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)
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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.
||Choledocholithiasis, preoperative evaluation, ERCP.
Stain SC, Cohen H, Tsuishoysha M, Donovan AJ. Choledocholithiasis. Endoscopic sphincterotomy or common bile duct exploration. Ann Surg 1991; 213: 627-634.
Stiegmann GV, Goff JS, Mansour A, Pearlman N, Reveille RM, Norton L. Precholecystectomy endoscopic cholangiography and stone removal is not superior to cholecystecomy, cholangiography, and common duct exploration. Am J Surg 1992; 163: 227-230.
National Institutes of Health. State-of-the-Science Conference Statement: ERCP for diagnosis and therapy. Gastrointest Endosc 2002; 56: 14-16. Available from: URL http://consensus.nih.gov/ta/020/020sos_intro.htm
Petelin JB. Surgical Management of common bile duct stones. Gastrointest Endosc 2002; 56: S183-189.
Kozarek RA. Laparoscopic cholecystectomy: Who does what, when and to whom? Endoscopy 1992; 24: 785-87.
Onken JE, Brazer SR, Eisen GM, Williams DM, Bouras EP, Delong ER, et al. Predicting the presence of choledocholithiasis in patients with symptomatic cholelithiasis. Am J Gastroenterol 1996; 91: 762-67.
Barkun AN, Barkun JS, Fried GM, Ghitulescu G, Steinmetz, Pham C, et al. Useful predictor of bile duct stones in patients undergoing laparoscopic cholecystectomy. McGill Gallstone Treatment Group. Ann Surg 1994; 220: 32-9.
Robertson GS, Jagger C, Johnson PR, Rathbone BJ, Wicks AC, Lloyd DM, et al. Selection criteria for preoperative endoscopic retrograde cholangiopancreatography in the laparoscopic era. Arch Surg 1996; 131: 89-94.
Erickson RA, Carlson B. The role of endoscopic retrograde cholangiopancreatography in patients with laparoscopic cholecystectomies. Gastroenterology 1995; 109: 252-63.
Eisen GM, Dominitz JA, Faigel DO, Goldstein JL, Kalloo AN, Petersen BT, et al. American Society for Gastrointestinal Endoscopy. Standards of Practice Committee. An annotated algorithm for the evaluation of choledocholithiasis. Gastrointest Endosc 2001; 53: 864-66.
Al-Mulhim AS, Sultan M. Non-invasive preoperative predictor of choledocholithiasis before laparoscopic cholecystectomy in Saudi patients with symptomatic cholelithiasis. Kuwait Medical Journal 2003; 35: 19-23.
Menezes N, Marson LP, Debeaux AC, Muir IM, Auld CD. Prospective analysis of a scoring system to predict choledocholithiasis. Br J Surg 2000; 87: 1176-81.
Neoptolemos JP, Carr-Locke DL, Fossard DP. Prospective randomized study of preoperative endoscopic sphincterotomy versus surgery alone for common bile duct stones. Br Med Jour 1987; 294: 470-74.
Dirección de Planeación y desarrollo de sistemas administrativos. Anuario Estadístico Enero-Diciembre 2005. Hospital General de México. Disponible en URL: http://www.hgm.salud.gob.mx/estadistica.
Greenfield L. Surgery. Scientific principles and practice. 3a ed. Philadelphia: Lippincott, Williams, Wilkins; 2001 p. 1028.
Collins C, Maguire D, Ireland A, Fitzgerald E, O´Sullivan GC. A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy. Natural history of choledocholithiasis revisited. Ann Surg 204; 239: 28-33.
NIH Consensus Conference. Gallstones and laparoscopic cholecystectomy. JAMA 1993; 269: 1018-24.
Tse F, Barkun JS, Barkun AN. The elective evaluation of patients with suspected choledocholithiasis undergoing laparoscopic cholecystectomy. Gastrointest Endosc 2004; 60: 437-48.
Sgourakis G, Dedemadi G, Stamatelopoulos A, Leandros E, Voros D, Karaliotas K. Predictors of common bile duct lithiasis in laparoscopic era. World J Gastroenterol 200; 11: 3267-72.
Topal B, Van de Moortel M, Fieuws S, Vanbeckevoort D, Van Steenbergen W, Aerts R, et al. The value of magnetic resonance cholangiopancreatography in predicting common bile duct stones in patients with gallstone disease. Br J Surg 2003; 90: 42-7.
Zidi SH, Prat F, Le Guen O, Rondeau Y, Rocher L, Fritsch J, et al. Use of magnetic resonance cholangiography in the diagnosis of choledocholithiasis: prospective comparison with a reference imaging method. Gut 1999; 44: 118-22.
>Year 2007, Issue 1