Predictors of Choledocholithiasis in Cholecystectomy Patients and Their Cutoff Values and Prediction Model in Korea in Comparison with the 2019 ASGE Guidelines

Overview

Journal Gut Liver

Specialty Gastroenterology

Date 2024 May 7

PMID 38712399

Authors

Jung Hun Woo

Hwanhyi Cho

Kihyun Ryu

Young Woo Choi

Sanghyuk Lee

Tae Hee Lee

Dae Sung Kim

In Seok Choi

Ju Ik Moon

Seung Jae Lee

Affiliations

Soon will be listed here.

Abstract

Background/aims: : In 2019, the American Society for Gastrointestinal Endoscopy (ASGE) established clinical predictors for choledocholithiasis. Our study was designed to evaluate these predictors within the Korean clinical context, establish cutoff values, and develop a predictive model.

Methods: : This retrospective study analyzed patients who underwent laparoscopic cholecystectomy. The relationships between choledocholithiasis and predictors including age, blood tests, and imaging findings were assessed through univariate and multivariate logistic regression analyses. We established Korean cutoff values for these predictors and developed a scoring system for choledocholithiasis using a multivariate logistic regression. The performance of this scoring system was then compared with that of the 2019 ASGE guidelines through a receiver operating characteristic curve.

Results: : We established Korean cutoff values for age (>70 years), alanine aminotransferase (>26.5 U/L), aspartate aminotransferase (>28.5 U/L), gamma-glutamyl transferase (GGT; >82.5 U/L), alkaline phosphatase (ALP; >77.5 U/L), and total bilirubin (>0.95 mg/dL). In the multivariate analysis, only age >70 years, GGT >77.5 U/L, ALP >77.5 U/L, and common bile duct dilatation remained significant. We then developed a new Korean risk stratification model from the multivariate analysis, with an area under the curve of 0.777 (95% confidence interval, 0.75 to 0.81). Our model was stratified into the low-risk, intermediate-risk, and high-risk groups with the scores being <1.0, 1.0-5.5, and >5.5, respectively.

Conclusions: : Predictors of choledocholithiasis in cholecystectomy patients and their cutoff values in Korean should be adjusted and further studies are needed to develop appropriate guidelines.

References

Yang M, Chen T, Wang S, Tsai Y, Su C, Wu C . Biochemical predictors for absence of common bile duct stones in patients undergoing laparoscopic cholecystectomy. Surg Endosc. 2007; 22(7):1620-4. DOI: 10.1007/s00464-007-9665-2. View

Kedia P, Tarnasky P . Endoscopic Management of Complex Biliary Stone Disease. Gastrointest Endosc Clin N Am. 2019; 29(2):257-275. DOI: 10.1016/j.giec.2018.11.004. View

Afzalpurkar S, Giri S, Kasturi S, Ingawale S, Sundaram S . Magnetic resonance cholangiopancreatography versus endoscopic ultrasound for diagnosis of choledocholithiasis: an updated systematic review and meta-analysis. Surg Endosc. 2022; 37(4):2566-2573. DOI: 10.1007/s00464-022-09744-3. View

Portincasa P, Ciaula A, de Bari O, Garruti G, Palmieri V, Wang D . Management of gallstones and its related complications. Expert Rev Gastroenterol Hepatol. 2015; 10(1):93-112. DOI: 10.1586/17474124.2016.1109445. View

Racz I, Rejchrt S, Hassan M . Complications of ERCP: ethical obligations and legal consequences. Dig Dis. 2008; 26(1):49-55. DOI: 10.1159/000109387. View

Hu K, Chu C, Wang H, Chang W, Lin S, Liu C . How Does Aging Affect Presentation and Management of Biliary Stones?. J Am Geriatr Soc. 2016; 64(11):2330-2335. DOI: 10.1111/jgs.14481. View

Freitas M, Bell R, Duffy A . Choledocholithiasis: evolving standards for diagnosis and management. World J Gastroenterol. 2006; 12(20):3162-7. PMC: 4087957. DOI: 10.3748/wjg.v12.i20.3162. View

Vacca G, Reginelli A, Urraro F, Sangiovanni A, Bruno F, Di Cesare E . Magnetic resonance severity index assessed by T1-weighted imaging for acute pancreatitis: correlation with clinical outcomes and grading of the revised Atlanta classification-a narrative review. Gland Surg. 2021; 9(6):2312-2320. PMC: 7804529. DOI: 10.21037/gs-20-554. View

He H, Tan C, Wu J, Dai N, Hu W, Zhang Y . Accuracy of ASGE high-risk criteria in evaluation of patients with suspected common bile duct stones. Gastrointest Endosc. 2017; 86(3):525-532. DOI: 10.1016/j.gie.2017.01.039. View

10.

Ukegjini K, Schmied B . [Diagnosis and treatment of acute cholecystitis]. Ther Umsch. 2020; 77(4):133-146. DOI: 10.1024/0040-5930/a001168. View

11.

Tazuma S . Gallstone disease: Epidemiology, pathogenesis, and classification of biliary stones (common bile duct and intrahepatic). Best Pract Res Clin Gastroenterol. 2006; 20(6):1075-83. DOI: 10.1016/j.bpg.2006.05.009. View

12.

Tse F, Liu L, Barkun A, Armstrong D, Moayyedi P . EUS: a meta-analysis of test performance in suspected choledocholithiasis. Gastrointest Endosc. 2008; 67(2):235-44. DOI: 10.1016/j.gie.2007.09.047. View

13.

Jacob J, Lee M, Chew E, Thrift A, Sealock R . Evaluating the Revised American Society for Gastrointestinal Endoscopy Guidelines for Common Bile Duct Stone Diagnosis. Clin Endosc. 2020; 54(2):269-274. PMC: 8039731. DOI: 10.5946/ce.2020.100. View

14.

Carriere V, Conway J, Evans J, Shokoohi S, Mishra G . Which patients with dilated common bile and/or pancreatic ducts have positive findings on EUS?. J Interv Gastroenterol. 2013; 2(4):168-171. PMC: 3655388. DOI: 10.4161/jig.23739. View

15.

Lee Y, Moon J . Optimal Predictive Criteria for Common Bile Duct Stones: The Search Continues. Clin Endosc. 2021; 54(2):147-148. PMC: 8039746. DOI: 10.5946/ce.2021.080. View

16.

Depew W . Endoscopic retrograde cholangiopancreatography. Can Med Assoc J. 1981; 125(6):531-3. PMC: 1862617. View

17.

Ragulin-Coyne E, Witkowski E, Chau Z, Ng S, Santry H, Callery M . Is routine intraoperative cholangiogram necessary in the twenty-first century? A national view. J Gastrointest Surg. 2013; 17(3):434-42. PMC: 4570242. DOI: 10.1007/s11605-012-2119-8. View

18.

Gallaher J, Charles A . Acute Cholecystitis: A Review. JAMA. 2022; 327(10):965-975. DOI: 10.1001/jama.2022.2350. View

19.

Mark D, Flamm C, Aronson N . Evidence-based assessment of diagnostic modalities for common bile duct stones. Gastrointest Endosc. 2002; 56(6 Suppl):S190-4. DOI: 10.1067/mge.2002.129010. View

20.

Buxbaum J, Fehmi S, Sultan S, Fishman D, Qumseya B, Cortessis V . ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis. Gastrointest Endosc. 2019; 89(6):1075-1105.e15. PMC: 8594622. DOI: 10.1016/j.gie.2018.10.001. View