Clinical models are inaccurate in predicting bile duct stones in situ for patients with gallbladder |
| |
Authors: | B Topal S Fieuws K Tomczyk R Aerts W Van Steenbergen C Verslype F Penninckx |
| |
Institution: | (1) Department of Abdominal Surgery, University Hospital Gasthuisberg, Herestraat 49, Leuven, 3000, Belgium;(2) Department of Biostatistics, University Hospital Gasthuisberg, Herestraat 49, Leuven, 3000, Belgium;(3) Department of Hepatology, University Hospital Gasthuisberg, Herestraat 49, Leuven, 3000, Belgium |
| |
Abstract: | Background The probability that a patient has common bile duct stones (CBDS) is a key factor in determining diagnostic and treatment
strategies. This prospective cohort study evaluated the accuracy of clinical models in predicting CBDS for patients who will
undergo cholecystectomy for lithiasis.
Methods From October 2005 until September 2006, 335 consecutive patients with symptoms of gallstone disease underwent cholecystectomy.
Statistical analysis was performed on prospective patient data obtained at the time of first presentation to the hospital.
Demonstrable CBDS at the time of endoscopic retrograde cholangiopancreatography (ERCP) or intraoperative cholangiography (IOC)
was considered the gold standard for the presence of CBDS.
Results Common bile duct stones were demonstrated in 53 patients. For 35 patients, ERCP was performed, with successful stone clearance
in 24 of 30 patients who had proven CBDS. In 29 patients, IOC showed CBDS, which were managed successfully via laparoscopic
common bile duct exploration, with stone extraction at the time of cholecystectomy. Prospective validation of the existing
model for CBDS resulted in a predictive accuracy rate of 73%. The new model showed a predictive accuracy rate of 79%.
Conclusion Clinical models are inaccurate in predicting CBDS in patients with cholelithiasis. Management strategies should be based on
the local availability of therapeutic expertise. |
| |
Keywords: | Cholecystectomy Common bile duct Management Prediction |
本文献已被 PubMed SpringerLink 等数据库收录! |
|