Predictive ability of choledocholithiasis indicators. A prospective evaluation

Area of Science:

• Gastroenterology
• Surgical Oncology
• Hepatobiliary Surgery

Background:

• Gallstone disease is common, with potential complications like common bile duct calculi (choledocholithiasis).
• Accurate prediction of choledocholithiasis is crucial for appropriate surgical management and preventing complications.

Purpose of the Study:

• To evaluate the predictive accuracy of various clinical and laboratory indicators for common bile duct calculi.
• To determine the optimal strategy for intraoperative cholangiography during cholecystectomy.

Main Methods:

• Prospective screening of 457 patients undergoing cholecystectomy for 11 predefined criteria of choledocholithiasis.
• Assessment of individual and combined predictive abilities of these criteria.
• Comparison of outcomes between patients with and without common bile duct exploration.

Main Results:

• Most criteria, excluding pancreatitis history, significantly predicted choledocholithiasis.
• A positive correlation was observed between the number of positive criteria and the incidence of common bile duct calculi.
• The total set of criteria demonstrated a high negative predictive value (98%) and sensitivity (89.5%).
• Common bile duct exploration led to increased complications and hospital stay compared to simple cholecystectomy.

Conclusions:

• A combination of criteria can reliably predict the presence of common bile duct calculi.
• Intraoperative cholangiography is recommended for patients with one or more positive predictive criteria.
• Routine cholangiography in patients without positive criteria is not indicated.