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Choledocholithiasis in acute calculous cholecystitis: guidelines and beyond.
Siddhartha Reddy1, Nitin Jagtap1, Rakesh Kalapala1
1Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India (Siddhartha Reddy, Nitin Jagtap, Rakesh Kalapala, Mohan Ramchandani, Sundeep Lakhtakia, Jahangeer Basha, Zaheer Nabi, Arun Karyampudi, Radhika Chavan, Manu Tandan, Rajesh Gupta, D. Nageshwar Reddy).
Annals of Gastroenterology
|March 3, 2021
Summary
Current guidelines for diagnosing common bile duct stones in acute calculous cholecystitis patients are inadequate. A new predictive model is needed to accurately identify choledocholithiasis in these cases.
Area of Science:
- Gastroenterology
- Hepatobiliary Surgery
- Diagnostic Accuracy
Background:
- Acute calculous cholecystitis (ACC) is a frequent gallstone complication necessitating cholecystectomy.
- Coexisting choledocholithiasis (bile duct stones) is common in ACC patients.
- Current guidelines for diagnosing choledocholithiasis in ACC require evaluation.
Purpose of the Study:
- To assess the diagnostic performance of existing American and European Society of Gastrointestinal Endoscopy (ASGE and ESGE) guidelines for choledocholithiasis in ACC patients.
- To identify independent predictors of choledocholithiasis in this population.
Main Methods:
- Retrospective study of 173 ACC patients (December 2018 - May 2019).
- Patients stratified by ASGE and ESGE guidelines for choledocholithiasis likelihood.
- Diagnostic performance measured; logistic regression used to find independent risk factors.
Main Results:
- 36.4% of ACC patients had confirmed choledocholithiasis.
- ASGE high likelihood criteria: 61.9% sensitivity, 83.4% specificity.
- ESGE high likelihood criteria: 49.2% sensitivity, 87.3% specificity.
- Independent predictors: elevated alkaline phosphatase (OR 4.26) and dilated common bile duct on ultrasound (OR 9.97). Acute biliary pancreatitis was a negative predictor (OR 0.36).
Conclusions:
- ASGE and ESGE guideline risk stratification is insufficient for diagnosing choledocholithiasis in ACC.
- A dedicated predictive model is recommended for suspected choledocholithiasis in ACC patients.
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