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. 2018 Jan;25(1):24-29.
doi: 10.1159/000479973. Epub 2017 Sep 15.

Performance of the Choledocholithiasis Diagnostic Score in Patients with Acute Cholecystitis

Catarina Gouveia  1 , Rui Loureiro  1 , Rosa Ferreira  1 , Alexandre Oliveira Ferreira  1 , António Alberto Santos  1 , Maria Pia Costa Santos  1 , Carolina Palmela  1 , Marília Cravo  1
Affiliations

Performance of the Choledocholithiasis Diagnostic Score in Patients with Acute Cholecystitis

Catarina Gouveia et al. GE Port J Gastroenterol. 2018 Jan.

Abstract
in English, Portuguese

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.

Introdução: A prevalência de coledocolitíase em doentes com colecistite aguda é estimada entre 9 e 16.5%. Não existem algoritmos validados para o diagnóstico de coledocolitíase neste grupo de doentes. Objectivo: Avaliar a performance do score de coledocolitíase proposto pela American Society for Gastrointestinal Endoscopy, em doentes com coleciste aguda. Material/Métodos: Foi realizado um estudo retrospectivo transversal, durante um período de 4 anos num hospital de cuidados secundários. Foram incluídos todos os doentes com diagnóstico codificado de colecistite aguda e pelo menos um dos seguintes procedimentos: colangiopancreatografia retrógrada, ecoendoscopia, colangiopancreatografia por ressonância magnética e colangiografia intra-operatória. Resultados: Em 4,369 doentes com diagnóstico de colecistite aguda, 40 (0.92%) tiveram suspeita clínica ou ecográfica de coledocolitíase. A idade média foi 68.1 ± 15 anos e 22 (55%) eram homens. Dos doentes incluídos, 31 (77.5%) tinham score elevado de coledocolitíase e 9 (22.5%) tinham score intermédio. Em 16/31 (51.6%) doentes com score elevado o diagnóstico de coledocolitíase foi confirmado. Em 2/9 (22.2%) doentes com score intermédio foi também confirmada coledocolitíase. O score elevado de probabilidade de coledocolitíase teve um valor preditivo positivo de 52% e uma sensibilidade de 89%. O score intermédio de probabilidade teve um valor preditivo positivo de 22% e uma sensibilidade de 11%. Discussão e Conclusões: A suspeita de coledocolitíase em doentes com colecistite aguda foi um evento raro (<1%). A sensibilidade do score elevado de probabilidade foi semelhante ao reportado na literatura (86%), mas o valor preditivo positivo foi significativamente menor (52 vs. 79.8%). Assim, em doentes com colecistite aguda e suspeita de coledocolitíase este score não deve ser utilizado, devendo ser realizado um método de diagnóstico antes da CPRE.

Keywords: Acute cholecystitis; Choledocholithiasis; Endoscopic retrograde cholangiopancreatography.

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References

    1. Nebiker CA, Baierlein SA, Beck S, von Flüe M, Ackermann C, Peterli R. Is routine MR cholangiopancreatography (MRCP) justified prior to cholecystectomy? Langenbecks Arch Surg. 2009;394:1005–1010. - PubMed
    1. Peng WK, Sheikh Z, Nixon SJ, Paterson-Brown S. Role of laparoscopic cholecystectomy in the early management of acute gallbladder disease. Br J Surg. 2005;92:586–591. - PubMed
    1. Videhult P, Sandblom G, Rudberg C, Rasmussen IC. Are liver function tests, pancreatitis and cholecystitis predictors of common bile duct stones? Results of a prospective, population-based, cohort study of 1,171 patients undergoing cholecystectomy. HPB (Oxford) 2011;13:519–527. - PMC - PubMed
    1. Chang CW, Chang WH, Lin CC, Chu CH, Wang TE, Shih SC. Acute transient hepatocellular injury in cholelithiasis and cholecystitis without evidence of choledocholithiasis. World J Gastroenterol. 2009;15:3788–3792. - PMC - PubMed
    1. Stott MA, Farrands PA, Guyer PB, Dewbury KC, Browning JJ, Sutton R. Ultrasound of the common bile duct in patients undergoing cholecystectomy. J Clin Ultrasound. 1991;19:73–76. - PubMed

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