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Prediction of common bile duct stones prior to cholecystectomy: a prospective validation of a discriminant analysis
E Trondsen1, B Edwin, O Reiertsen
1Department of Surgical Gastroenterology, Central Hospital of Akershus, Nordbyhagen, Norway.
Background:
Selection routines for preoperative endoscopic retrograde cholangiopancreatography (ERCP) in patients with symptomatic gallstone disease should give a low frequency of both false-negative ERCP results and residual common bile duct stones (CBDS).
Objective:
To validate a discriminant function (DF) based on retrospectively collected data, for characterization of patients with symptomatic gallstone disease as regards presence of CBDS, and to compare clinical, ultrasonographic, and DF characterization.
Design:
Prospective registration of CBDS criteria in consecutive patients with symptomatic gallstone disease.
Setting:
A department of surgical gastroenterology in a Norwegian central hospital.
Patients:
One hundred ninety-two patients with gallbladder stones.
Intervention:
Laparoscopic cholecystectomy or ERCP with or without endoscopic sphincterotomy.
Main Outcome Measurements:
Sensitivity and specificity of the clinical, ultrasonographic, and DF characterizations, and test of the validity of the DF.
Results:
Thirty-two patients had CBDS. The clinical criteria of CBDS were present in 152 patients (79.2%): 21.1% of these patients had CBDS and there were no false-negative results (sensitivity, 100%; specificity, 25%). The risk of CBDS in patients with normal bile ducts at ultrasonographic examination was 8 of 124, and in patients with dilated ducts or suspected CBDS, 17 of 47 (sensitivity, 68%; specificity, 80%). The DF was positive in 50 patients (26%): 60% of these had CBDS, and there were 2 false-negative results (sensitivity, 94%; specificity, 88%). A discriminant analysis of the prospectively registered data selected the same set of CBDS criteria, and a new DF did not alter the characterization of any patient.
Conclusions:
Clinical characterization had a higher sensitivity for CBDS detection than ultrasonography alone, but a lower specificity. The DF analysis was both more sensitive and specific than ultrasonography, and seemed efficient in selecting symptomatic gallstone patients for ERCP. It was reproducible and simple to use.