Preoperative predictors of choledocholithiasis in patients underwent ERCP

Abstract

In General surgery practice, acute cholecystitis (AC) often concomitant choledocholithiasis (CDL). Advances of biochemical liver function evaluation provides opportunity to differentiate between AC and CDL. However, there is insufficient literature for preoperative prediction for CDL with AC. The aims of this study are to define preoperative prediction factors (laboratory values, diagnostic imaging) for CDL. Also, try to identify preoperative predictor factors for pancreatitis in case of CDL. We conducted a retrospective review of 304 patients who underwent ERCP in the period from January 2015 until June 2020. Excluding criteria was following: preoperative laboratory and imaging (liver function test results, abdominal ultrasound) insufficient, Oddi sphincter dysfunction, CBD obstruction due to tumor compression. CDL defined as common bile duct stone confirmed with ERCP. We used some international guidelines and classifications (including: UB/TG-18-cholangitis criteria, ASGE-guideline for predict CBD stone, Atlanta classification for pancreatitis). The statistical analysis using independent samples T test, and one-way ANOVA. A total 304 patient reviewed and 226 (74.4%) was high risk group, 31 (10.1%) was intermediate risk group, 47 (15.4%) was low risk group due to ASGE guideline. According to independent samples T test, some variables (including: age, serum amylase, GGT, and cholangitis) are statistically significant for pancreatitis. Previous study found that nearly 18% of patients with AC have concurrent CDL. According to this reason, to identify CDL in case of AC is an important issue practically. American Society for Gastrointestinal Endoscopy developed the ASGE guideline focused at recognizing patients those are at high risk for CDL. In our study, 226 (74.4%) of all positive ERCP cases matched with high risk category of ASGE guideline. This result shown as the ASGE guideline probably suitable for our region. Also, we observed that some variables (age, serum amylase, GGT, and cholangitis) might predict pancreatitis in case of CDL. In case of clinical suspicion for CDL, ASGE guideline able to identify CDL. Also, some variables (age, serum amylase, GGT, and cholangitis) might predict pancreatitis in case of CDL.