Endoscopic retrograde cholangiopancreatography forsuspected choledocholithiasis： From guidelines to clinicalpractice

• 作者: Joana Magalh?es Bruno Rosa José Cotter
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: CHOLEDOCHOLITHIASIS Endoscopic retrograde CHOLANGIOPANCREATOGRAPHY CHOLANGITIS COMMON bileduct STONES DILATED COMMON bile duct
• 年，卷（期）: 2015,（2）
• 页码范围: 128-134
• 页数: 7页
• 分类号: R

摘要

AIM： To study the practical applicability of the AmericanSociety for Gastrointestinal Endoscopy guidelinesin suspected cases of choledocholithiasis.METHODS： This was a retrospective single centerstudy, covering a 4-year period, from January 2010to December 2013. All patients who underwentendoscopic retrograde cholangiopancreatography（ERCP） for suspected choledocholithiasis were included.Based on the presence or absence of predictors ofcholedocholithiasis （clinical ascending cholangitis,common bile duct （CBD） stones on ultrasonography（US）, total bilirubin 〉 4 mg/dL, dilated CBD on US,total bilirubin 1.8-4 mg/dL, abnormal liver functiontest, age 〉 55 years and gallstone pancreatitis）,patients were stratified in low, intermediate or highrisk for choledocholithiasis. For each predictor andrisk group we used the χ 2 to evaluate the statisticalassociations with the presence of choledocolithiasisat ERCP. Statistical analysis was performed usingSPSS version 21.0. A P value of less than 0.05 wasconsidered statistically significant.RESULTS： A total of 268 ERCPs were performed forsuspected choledocholithiasis. Except for gallstonepancreatitis （P = 0.063）, all other predictors of cho-ledocholitiasis （clinical ascending cholangitis, P = 0.001;CBD stones on US, P ≤ 0.001; total bilirubin 〉 4 mg/dL, P = 0.035; total bilirubin 1.8-4 mg/dL, P = 0.001;dilated CBD on US, P ≤ 0.001; abnormal liver functiontest, P = 0.012; age 〉 55 years, P = 0.002） showed astatistically significant association with the presence ofcholedocholithiasis at ERCP. Approximately four fifthsof patients in the high risk group （79.8%, 154/193patients） had confirmed choledocholithiasis on ERCP,vs 34.2% （25/73 patients） and 0 （0/2 patients） in theintermediate and low risk groups, respectively. Thedefinition of ＂high risk group＂ had a sensitivity of 86%,positive predictive value 79.8% and specificity 56.2%for the presence of choledocholithiasis at ERCP.CONCLUSION： The guidelines should be consideredto