Evaluation of the predictors of choledocholithiasis: Comparative analysis of clinical, biochemical, radiological, radionuclear, and intraoperative parameters
Sm. Bose et al., Evaluation of the predictors of choledocholithiasis: Comparative analysis of clinical, biochemical, radiological, radionuclear, and intraoperative parameters, SURG TODAY, 31(2), 2001, pp. 117-122
This prospective study was performed to assess the predictive ability of th
e various indicators of common bile duct (CBD) calculi, individually or in
combination, by analyzing 88 patients with gallstone disease. The patients
were classified into two groups according to the presence of 10 predefined
criteria. Of 53 patients with one or more risk factors (group 2), 26 harbor
ed CBD calculi; none of 35 patients with no risk factors (group 1) had CBD
stones. Jaundice correlated best, with a sensitivity of 69%; and pancreatit
is had the lowest sensitivity (12%). Elevated serum bilirubin and alkaline
phosphatase levels correlated better than liver enzymes and serum amylase.
The sensitivity and negative predictive value of cholescintigraphy scanning
for diagnosing CBD calculi were better than those of ultrasonography, the
sensitivity being 84% versus 50% and the negative predictive value 95% vers
us 82%. Endoscopic retrograde cholangiopancreaticography was successful in
94% of the patients, and CBD calculi were diagnosed in 74%. Moreover, perop
erative cholangiography was 100% sensitive with no false-positive results.
Ultimately, a palpable stone at surgery was the best predictor. When all th
e criteria were analyzed, it was found that as the number of criteria incre
ased so did the percentage of patients harboring CBD calculi.