Gallstone Pancreatitis and Choledocholithiasis: Using Imaging and Laboratory Trends to Predict the Likelihood of Persistent Stones at Cholangiography

  • Nikhil Panda
  • Yuchiao Chang
  • Nalin Chokengarmwong
  • Myriam Martinez
  • Liyang Yu
  • Peter J. Fagenholz
  • Haytham A. Kaafarani
  • David R. King
  • Marc A. DeMoya
  • George C. Velmahos
  • D. Dante Yeh
Original Scientific Report
  • 49 Downloads

Abstract

Background

Patients with gallstone pancreatitis (GP) or choledocholithiasis (CDL) may have common bile duct (CBD) stones that persist until cholangiography. The aim of this study is to evaluate pre-cholangiogram factors that predict persistent CBD stones.

Methods

Multiple logistic regression analyses were performed to identify demographic, laboratory, and radiologic predictors of persistent CBD stones and non-therapeutic cholangiography among adults with GP or CDL.

Results

In 152 patients from 2010 to 2015, preoperative diagnosis, presence of a CBD stone on US, and age ≥ 60 years were associated with persistent CBD stones. Two risk factors alone had a PPV of 88% and the absence of all risk factors had a NPV of 94%. Age < 60 years and the absence of a CBD stone on US were most predictive of non-therapeutic cholangiography.

Conclusion

Age, LFTs, and US help predict persistent CBD stones in patients initially presenting with GP or CDL and help minimize non-therapeutic preoperative cholangiography.

Notes

Compliance with ethical standards

Conflict of interest

All the authors declare that they have no conflict of interest.

References

  1. 1.
    Forsmark CE, Baillie J (2007) AGA institute technical review on acute pancreatitis. Gastroenterology 132(5):2022–2044CrossRefPubMedGoogle Scholar
  2. 2.
    Forsmark CE, Swaroop Vege S, Wilcox CM (2016) Acute Pancreatitis. N Engl J Med 375(20):1972–1981CrossRefPubMedGoogle Scholar
  3. 3.
    Tse F, Yuan Y (2012) Early routine endoscopic retrograde cholangiopancreatography strategy versus early conservative management strategy in acute gallstone pancreatitis. Cochrane Database Syst Rev 5:Cd009779Google Scholar
  4. 4.
    Fogel EL, Sherman S (2014) ERCP for gallstone pancreatitis. N Engl J Med 370(2):150–157CrossRefPubMedGoogle Scholar
  5. 5.
    Clair DG et al (1993) Routine cholangiography is not warranted during laparoscopic cholecystectomy. Arch Surg 128(5):551–554 (discussion 554-555) CrossRefPubMedGoogle Scholar
  6. 6.
    Lillemoe KD et al (1992) Selective cholangiography. Current role in laparoscopic cholecystectomy. Ann Surg 215(6):669–676CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Sherman JL et al (2015) Validation and improvement of a proposed scoring system to detect retained common bile duct stones in gallstone pancreatitis. Surgery. 157(6):1073–1079CrossRefPubMedGoogle Scholar
  8. 8.
    Barkun AN et al (1994) Useful predictors of bile duct stones in patients undergoing laparoscopic cholecystectomy. McGill gallstone treatment group. Ann Surg 220(1):32–39CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Cohen ME et al (2001) Prediction of bile duct stones and complications in gallstone pancreatitis using early laboratory trends. Am J Gastroenterol 96(12):3305–3311CrossRefPubMedGoogle Scholar
  10. 10.
    Freitas ML, Bell RL, Duffy AJ (2006) Choledocholithiasis: evolving standards for diagnosis and management. World J Gastroenterol WJG 12(20):3162–3167CrossRefPubMedGoogle Scholar
  11. 11.
    Cronan JJ (1986) US diagnosis of choledocholithiasis: a reappraisal. Radiology 161(1):133–134CrossRefPubMedGoogle Scholar
  12. 12.
    Peng WK et al (2005) Role of liver function tests in predicting common bile duct stones in acute calculous cholecystitis. Br J Surg 92(10):1241–1247CrossRefPubMedGoogle Scholar
  13. 13.
    Riciardi R, Islam S, Canete JJ, Arcand PL, Stoker ME (2003) Effectiveness and long-term results of laparoscopic common bile duct exploration. Surg Endosc 2003(17):19–22CrossRefGoogle Scholar
  14. 14.
    Moon JH et al (2005) The detection of bile duct stones in suspected biliary pancreatitis: Comparison of MRCP, ERCP, and intraductal US. Am J Gastroenterol 100:1051–1057CrossRefPubMedGoogle Scholar
  15. 15.
    Chang JH et al (2012) Role of magnetic resonance cholangiopancreatography for choledocholithiasis: analysis of patients with negative MRCP. Scand J Gastroenterol 47:217–224CrossRefPubMedGoogle Scholar
  16. 16.
    Richard F, Boustany M, Britt LD (2013) Accuracy of magnetic resonance cholangiopancreatography for diagnosing stones in the common bile duct in patients with abnormal intraoperative cholangiograms. Am J Surg 205:371–373CrossRefPubMedGoogle Scholar
  17. 17.
    Aydelotte JD et al (2015) Use of magnetic resonance cholangiopancreatography in clinical practice: not as good as we once thought. J Am Coll Surg 221:215–219CrossRefPubMedGoogle Scholar
  18. 18.
    Singhvi G, Ampara R, Baum J, Gumaste V (2016) ASGE guidelines result in cost-saving in the management of choledocholithiasis. Ann Gastroenterol Q Publ Hell Soc Gastroenterol 29:85–90Google Scholar
  19. 19.
    Maple JT et al (2010) The role of endoscopy in the evaluation of suspected choledocholithiasis. Gastrointest Endosc 71:1–9CrossRefPubMedGoogle Scholar
  20. 20.
    Sgourakis G et al (2004) Predictors of common bile duct lithiasis in laparoscopic era. World J Gastroenterol 11:3267–3272CrossRefGoogle Scholar
  21. 21.
    Trondsen F, Edwin B, Reiertsen O, Fagertun H, Rosseland AR (1995) Selection criteria for endoscopic retrograde cholangiopancreaticography (ERCP) in patients with gallstone disease. World J Surg 19:852–856.  https://doi.org/10.1007/BF00299784 CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Nikhil Panda
    • 1
  • Yuchiao Chang
    • 2
  • Nalin Chokengarmwong
    • 2
  • Myriam Martinez
    • 1
  • Liyang Yu
    • 2
  • Peter J. Fagenholz
    • 1
  • Haytham A. Kaafarani
    • 1
  • David R. King
    • 1
  • Marc A. DeMoya
    • 1
  • George C. Velmahos
    • 1
  • D. Dante Yeh
    • 3
  1. 1.Division of Trauma and Acute Care Surgery, Department of SurgeryMassachusetts General HospitalBostonUSA
  2. 2.Department of MedicineMassachusetts General HospitalBostonUSA
  3. 3.Division of Trauma and Surgical Critical CareUniversity of MiamiMiamiUSA

Personalised recommendations