Predictive Factors for Choledocholithiasis in Symptomatic Gallstone Patients

Abstract

Background: Complications of common bile duct stones (choledocholithiasis) can vary from simple biliary colic to lifethreatening conditions. Approximately 10-25% of symptomatic gallstone patients may be associated common bile duct stone (CBDS) at the time of diagnosis. Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard for diagnosis and treatment of CBDS but this procedure is invasive and has high morbidity and mortality rate. Moreover, routine preoperative ERCP is not cost-effectiveness.

Objective: This study aimed to determine the predictive factors for predicting CBDS in symptomatic gallstone patients.

Material and method: Between March 2008 and February 2011, 149 symptomatic gallstone patients who underwent preoperative ERCP or intraoperative cholangiography (IOC) during laparoscopic cholecystectomy at Her Royal Highness Princess Mahachakri Sirindorn Medical Center (MSMC) were evaluated by clinical presentations, biochemical blood test and transabdominal ultrasonography. The preoperative predictive factors for choledocholithiasis were determined by univariate and multivariate analysis.

Results: Age morethan 55 years, history of jaundice, history of cholangitis, total bilirubin >2.0 mg/dL, Aspartate aminotransferase >2 times the normal value, Alanine aminotransferase >3 times the normal value, Alkaline phosphatase >300 U/L, Gamma glutamyltranspeptidase >90 U/L, sized of CBD >8 mm and visualized CBD stones by ultrasonography were found to be associated with CBD stones by univariate analysis. For multivariate analysis, history of cholangitis (p-value 0.027), sized of CBD >8 mm (p-value 0.003) and detected CBD stones by ultrasonography (p-value 0.000) were found to be predictive factors for choledocholithiasis.

Conclusion: This study presented that the helpful preoperative predictive factors for choledocholithiasis were history of cholangitis, dilatation of CBD >8 mm and visualized CBD stone by ultrasonography.