Predictive factors for synchronous common bile duct stone in patients with symptomatic cholelithiasis
Charatcharoenwitthaya, P.; Sattawatthamrong, Y.; Manatsathit, S.; Tanwandee, T.; Leelakusolvong, S.; Kachintorn, U.; Leungrojanakul, P.; Boonyapisit, S.; Pongprasobchai, S.
Journal of the Medical Association of Thailand 87(2): 131-136
2004
ISSN/ISBN: 0125-2208 PMID: 15061295 Document Number: 2431
Background : Laparoscopic cholecystectomy (LC) has become the treatment of choice for patients with symptomatic cholelithiasis. About 8-15 per cent of patients with symptomatic gallstones may bear associated common bile duct (CBD) stones, The management of choledocholithiasis in the laparoscopic era remain debatable. Although pre-operative endoscopic cholangiopancreatography (ERCP) is available and highly accurate in the detection of CBD stones, its routine use is controversial because of its inherent disadvantages. Objective : The aim of this retrospective study was to generate an effective predictive model for bile duct stones detection by pre-operative ERCP. Method : Twelve pre-operative clinical, biochemical and sonographic variables from 206 consecutive patients who underwent pre-operative ERCP with LC for gallstones with/without CBD stones from October 1998 to December 2000 were retrospectively analysed Results :143 of the 206 patients with gallstones were found to have CBD stones. The mean age was 61 (20-93) yr old, and 55.9 per cent were female. Multivariate analysis showed a high predictive value for the presence of CBD stones in patients aged gtoreq 55 yr old (Odd radio (OR) 1.03, 95% confidence interval (95% CI) 1.01-1.05), jaundice (OR 2.7, 95% CI 1.7-4.8), elevated alkaline phosphatase (OR 1.002, 95% CI 1.000-1.005), CBD dilatation on ultrasound (OR 3.8, 95% CI 1.8-8) and CBD stone on ultrasound. Conclusion : The important clinical presentations and investigating could allow more appropriate use of pre-operative ERCP in patients who have symptomatic gallstones with a suspected CBD stone prior to cholecystectomy.
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