Coexisting common bile duct stones in patients with acute cholecystitis — predictors and the role of current guidelines

Aims To evaluate the utility of the main international guidelines and proposed algorithms for the prediction of concurrent choledocholithiasis in patients with acute cholecystitis

Methods An observational retrospective study including hospitalized patients admitted with acute cholecystitis between January 2016 and December 2020 at Edit Wolfson Medical Center.

Results A total of 155 patients with AC, mean age 67.73±15.86 years were included. Fifty patients (32.2%) had confirmed CDL. The criteria for high likelihood of CDL according to the ASGE guidelines had a sensitivity and specificity of 61.9% (95% confidence interval [CI] 48.8-73.9) and 83.4% (95%CI 75.4-90.0) for predicting CDL. The high likelihood criteria according to the ESGE guidelines had sensitivity and specificity of 49.2% (95%CI 36.4-62.1) and 87.3% (95%CI 79.6-92.9). On logistic regression analysis, an alkaline phosphatase level above the upper limit of normal (P=0.003(and a dilated common bile duct on ultrasound (P=0.001) were independent positive predictors for choledocholithiasis, while acute biliary pancreatitis was an independent negative predictor (P=0.030) [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] (Fig. 1).

Conclusions The performance of the ASGE and ESGE guidelines’ risk stratification criteria for predicting CDL specifically in patients with AC is lacking. Further studies are needed in order to create a more specific predictive model in this selected group of patients

Table 1

Publication History

Article published online:
14 April 2023

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