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World J Surg. 2018 Oct;42(10):3143-3149. doi: 10.1007/s00268-018-4618-6.

Gallstone Pancreatitis and Choledocholithiasis: Using Imaging and Laboratory Trends to Predict the Likelihood of Persistent Stones at Cholangiography.

Author information

1
Division of Trauma and Acute Care Surgery, Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA. nikhil.panda@mgh.harvard.edu.
2
Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB-425, Boston, MA, 02114, USA.
3
Division of Trauma and Acute Care Surgery, Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
4
Division of Trauma and Surgical Critical Care, University of Miami, 1800 N.W. 10th Ave, Miami, FL, 33136, USA.

Abstract

BACKGROUND:

Patients with gallstone pancreatitis (GP) or choledocholithiasis (CDL) may have common bile duct (CBD) stones that persist until cholangiography. The aim of this study is to evaluate pre-cholangiogram factors that predict persistent CBD stones.

METHODS:

Multiple logistic regression analyses were performed to identify demographic, laboratory, and radiologic predictors of persistent CBD stones and non-therapeutic cholangiography among adults with GP or CDL.

RESULTS:

In 152 patients from 2010 to 2015, preoperative diagnosis, presence of a CBD stone on US, and age ≥ 60 years were associated with persistent CBD stones. Two risk factors alone had a PPV of 88% and the absence of all risk factors had a NPV of 94%. Age < 60 years and the absence of a CBD stone on US were most predictive of non-therapeutic cholangiography.

CONCLUSION:

Age, LFTs, and US help predict persistent CBD stones in patients initially presenting with GP or CDL and help minimize non-therapeutic preoperative cholangiography.

PMID:
29626246
DOI:
10.1007/s00268-018-4618-6
[Indexed for MEDLINE]

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