Performance of the Choledocholithiasis Diagnostic Score in Patients with Acute Cholecystitis
Introduction: The prevalence of choledocholithiasis among patients with acute cholecystitis is estimated to be between 9 and 16.5%. There are no validated algorithms to predict choledocholithiasis in this group of patients. Aim: The aim of this study was to evaluate the performance of the choledocho...
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| Format: | Article |
| Language: | English |
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Karger Publishers
2017-09-01
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| Series: | GE: Portuguese Journal of Gastroenterology |
| Subjects: | |
| Online Access: | http://www.karger.com/Article/FullText/479973 |
| _version_ | 1828872390915915776 |
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| author | Catarina Gouveia Rui Loureiro Rosa Ferreira Alexandre Oliveira Ferreira António Alberto Santos Maria Pia Costa Santos Carolina Palmela Marília Cravo |
| author_facet | Catarina Gouveia Rui Loureiro Rosa Ferreira Alexandre Oliveira Ferreira António Alberto Santos Maria Pia Costa Santos Carolina Palmela Marília Cravo |
| author_sort | Catarina Gouveia |
| collection | DOAJ |
| description | Introduction: The prevalence of choledocholithiasis among patients with acute cholecystitis is estimated to be between 9 and 16.5%. There are no validated algorithms to predict choledocholithiasis in this group of patients. Aim: The aim of this study was to evaluate the performance of the choledocholithiasis diagnostic score proposed by the American Society for Gastrointestinal Endoscopy, in patients with acute cholecystitis. Material/Methods: A retrospective cross-sectional study, covering a 4-year period at a secondary care hospital, was performed. All patients with an encoded diagnosis of acute cholecystitis and with at least one of the following procedures were included: endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound, magnetic resonance cholangiopancreatography, and intraoperative cholangiography. Results: Among 4,369 patients with the diagnosis of acute cholecystitis, 40 (0.92%) had clinical or sonographic suspicion of choledocholithiasis. Their mean age was 68.1 ± 15 years, and 22 (55%) were men. Thirty-one of the patients included (77.5%) had a high risk of choledocholithiasis, and 9 (22.5%) had an intermediate risk. In 16 (51.6%) of the 31 patients with a high risk, the diagnosis of choledocholithiasis was confirmed. In 2 (22.2%) of the 9 patients with an intermediate risk, the diagnosis of choledocholithiasis was also confirmed. The high risk score for choledocholithiasis had a positive predictive value of 52% and a sensitivity of 89%. The intermediate risk score for choledocholithiasis had a positive predictive value of 22% and a sensitivity of 11%. Discussion and Conclusions: Suspicion of choledocholithiasis in patients with acute cholecystitis was a rare event (<1%). The sensitivity of the high risk score was approximately the same as found in published series with patients with suspected choledocholithiasis overall (86%), while the positive predictive value was substantially lower (52 vs. 79.8%). Therefore, in patients with acute cholecystitis and suspected choledocholithiasis, this score should not be used to screen for common bile duct stones, and a sensitive method should be used prior to ERCP. |
| first_indexed | 2024-12-13T06:52:52Z |
| format | Article |
| id | doaj.art-ec5577138946436bb94607d476770b25 |
| institution | Directory Open Access Journal |
| issn | 2341-4545 2387-1954 |
| language | English |
| last_indexed | 2024-12-13T06:52:52Z |
| publishDate | 2017-09-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | GE: Portuguese Journal of Gastroenterology |
| spelling | doaj.art-ec5577138946436bb94607d476770b252022-12-21T23:56:06ZengKarger PublishersGE: Portuguese Journal of Gastroenterology2341-45452387-19542017-09-0110.1159/000479973479973Performance of the Choledocholithiasis Diagnostic Score in Patients with Acute CholecystitisCatarina GouveiaRui LoureiroRosa FerreiraAlexandre Oliveira FerreiraAntónio Alberto SantosMaria Pia Costa SantosCarolina PalmelaMarília CravoIntroduction: The prevalence of choledocholithiasis among patients with acute cholecystitis is estimated to be between 9 and 16.5%. There are no validated algorithms to predict choledocholithiasis in this group of patients. Aim: The aim of this study was to evaluate the performance of the choledocholithiasis diagnostic score proposed by the American Society for Gastrointestinal Endoscopy, in patients with acute cholecystitis. Material/Methods: A retrospective cross-sectional study, covering a 4-year period at a secondary care hospital, was performed. All patients with an encoded diagnosis of acute cholecystitis and with at least one of the following procedures were included: endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound, magnetic resonance cholangiopancreatography, and intraoperative cholangiography. Results: Among 4,369 patients with the diagnosis of acute cholecystitis, 40 (0.92%) had clinical or sonographic suspicion of choledocholithiasis. Their mean age was 68.1 ± 15 years, and 22 (55%) were men. Thirty-one of the patients included (77.5%) had a high risk of choledocholithiasis, and 9 (22.5%) had an intermediate risk. In 16 (51.6%) of the 31 patients with a high risk, the diagnosis of choledocholithiasis was confirmed. In 2 (22.2%) of the 9 patients with an intermediate risk, the diagnosis of choledocholithiasis was also confirmed. The high risk score for choledocholithiasis had a positive predictive value of 52% and a sensitivity of 89%. The intermediate risk score for choledocholithiasis had a positive predictive value of 22% and a sensitivity of 11%. Discussion and Conclusions: Suspicion of choledocholithiasis in patients with acute cholecystitis was a rare event (<1%). The sensitivity of the high risk score was approximately the same as found in published series with patients with suspected choledocholithiasis overall (86%), while the positive predictive value was substantially lower (52 vs. 79.8%). Therefore, in patients with acute cholecystitis and suspected choledocholithiasis, this score should not be used to screen for common bile duct stones, and a sensitive method should be used prior to ERCP.http://www.karger.com/Article/FullText/479973CholedocholithiasisAcute cholecystitisEndoscopic retrograde cholangiopancreatography |
| spellingShingle | Catarina Gouveia Rui Loureiro Rosa Ferreira Alexandre Oliveira Ferreira António Alberto Santos Maria Pia Costa Santos Carolina Palmela Marília Cravo Performance of the Choledocholithiasis Diagnostic Score in Patients with Acute Cholecystitis GE: Portuguese Journal of Gastroenterology Choledocholithiasis Acute cholecystitis Endoscopic retrograde cholangiopancreatography |
| title | Performance of the Choledocholithiasis Diagnostic Score in Patients with Acute Cholecystitis |
| title_full | Performance of the Choledocholithiasis Diagnostic Score in Patients with Acute Cholecystitis |
| title_fullStr | Performance of the Choledocholithiasis Diagnostic Score in Patients with Acute Cholecystitis |
| title_full_unstemmed | Performance of the Choledocholithiasis Diagnostic Score in Patients with Acute Cholecystitis |
| title_short | Performance of the Choledocholithiasis Diagnostic Score in Patients with Acute Cholecystitis |
| title_sort | performance of the choledocholithiasis diagnostic score in patients with acute cholecystitis |
| topic | Choledocholithiasis Acute cholecystitis Endoscopic retrograde cholangiopancreatography |
| url | http://www.karger.com/Article/FullText/479973 |
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