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A validated score predicting common bile duct stone in patients hospitalized with acute calculus cholecystitis: a multi-center retrospective study

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Abstract

Background

Concomitant common bile duct (CBD) stone in the setting of acute calculous cholecystitis (ACC) should be suspected once abnormal liver indices are noticed.

Aim

We aimed to identify predictors of CBD stone in patients hospitalized with ACC.

Methods

We performed a retrospective multi-center, case-controlled, study from 1st of January 2016 until the 31th of December 2018. Inclusion criteria included patients with an established diagnosis of ACC based on clinical, laboratory and radiological criteria and who had an endoscopic ultrasound (EUS) for suspected CBD stone. One-hundred and twelve patients were included, of these fifty-three patients (47.3%) were diagnosed with CBD stone by EUS.

Results

In univariate analysis, Age (OR 1.038, P = 0.001), total bilirubin (mg/dl) (OR 1.429, P = 0.02) and CBD width (mm) by US (OR 1.314, P = 0.01) were statistically significant in predicting CBD stone and remained significant in multivariate regression analysis. We developed a diagnostic score that included these three parameters, with assignment of weights for each variable according to the coefficient estimate. A low cut-off score of 0 was associated with sensitivity of 100% for CBD stone, whereas a high cut-off score of 3 was associated with sensitivity of 10% and specificity of 96.6% with a positive predictive value of 67% (ROC of 0.7558). We validated this score with an independent cohort (ROC of 0.7416) with a sensitivity of 46.6%, a specificity of 91.5% and a PPV of 87.1%.

Conclusion

We recommend incorporating this score as an aid for stratifying patients with ACC into low or high probability for concomitant CBD stone.

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Abbreviations

ACC:

Acute calculus cholecystitis

CBD:

Common bile duct

EUS:

Endoscopic ultrasound

MRCP:

Magnetic resonance cholangiopancreatography

ASGE:

American Society for Gastrointestinal Endoscopy

US:

Ultrasound

ESGE:

European Society of Gastrointestinal Endoscopy

ALT:

Alanine aminotransferase

AST:

Aspartate transaminase

ALP:

Alkaline phosphatase

GGT:

Gamma-glutamyl transferase

WBC:

White blood cells

OR:

Odds ratio

ROC:

Receiver operating characteristics

PPV:

Positive predictive value

NPV:

Negative predictive value

ERCP:

Endoscopic retrograde cholangiopancreatography

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel

    Tawfik Khoury, Anas Kadah & Wisam Sbeit

  2. Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel

    Tawfik Khoury, Anas Kadah, Amir Mari, Mahmud Mahamid & Wisam Sbeit

  3. Gastroenterology and Endoscopy Units, The Nazareth Hospital, EMMS, Nazareth, Israel

    Tawfik Khoury, Amir Mari & Mahmud Mahamid

  4. Gastroenterology Department, Sharee Zedek Medical Center, Jerusalem, Israel

    Mahmud Mahamid

  5. Gastroenterology Department, Hadassah Medical Organization-Hebrew University, Jerusalem, Israel

    Itai Kalisky & Lior Katz

Authors
  1. Tawfik Khoury
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  2. Anas Kadah
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  3. Amir Mari
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  4. Itai Kalisky
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  7. Wisam Sbeit
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Contributions

TK and WS contributed to the design of the manuscript. TK, AK, MM, and WS contributed to data analysis and interpretation. All authors contributed to data collection and analysis. TK, AM and WS contributed to critical revision of the manuscript and all authors approved the final version to be published.

Corresponding author

Correspondence to Tawfik Khoury.

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Disclosures

Drs. Tawfik Khoury, Anas Kadah, Amir Mari, Itai Kalisky, Lior Katz, Mahmud Mahamid and Wisam Sbeit have no conflicts of interest or financial ties to disclose.

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Khoury, T., Kadah, A., Mari, A. et al. A validated score predicting common bile duct stone in patients hospitalized with acute calculus cholecystitis: a multi-center retrospective study. Surg Endosc 35, 3709–3715 (2021). https://doi.org/10.1007/s00464-020-07853-5

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