USEFUL PREDICTORS OF BILE-DUCT STONES IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY

Objective The authors determined the most useful predictors of common bile duct (CBD) stones as diagnosed by endoscopic retrograde cholangio pancreatography (PROP) in patients who underwent laparoscopic cholecys tectomy (LC). Methods Prospective and retrospective collection of hist orical, biochemical and ultrasonographic data was used. Receiver opera ting characteristics curve analysis was used to determine optimal bioc hemical cut-off values. Multivariate analysis using logistic regressio n with generation of the best model identifying independent predictors of CBD stones also was employed. Prospective validation of the model was performed on an independent group of patients. Results Endoscopic retrograde cholangiopancreatographies were performed before LC in 106 patients, and after LC in 33. Only four of ten clinical variables eval uated independently predicted the presence of CBD stones. The optimal model predicted a 94% probability of CBD stones in a patient older tha n 55 years of age who presented with an elevated bilirubin (over 30 mu mol/L) and positive ultrasound findings (a dilated CBD, and a CBD sto ne seen on ultrasound). This model was validated prospectively in a su bsequent series of 49 patients in which the probability of CBD stone w as only 8% when all four predictors were absent. Conclusions The ident ified independent clinical predictors of a CBD stone helps select a po pulation of symptomatic gallstone bearers who benefit most from cholan giographic assessment.