Current clinical algorithms for predicting common bile duct stones have only moderate accuracy.

A risk stratified approach for selecting patients likely to harbor common bile duct (CBD) stones to proceed directly to endoscopic or surgical stone clearance, rather than less invasive testing, has been proposed. We aimed to assess the performance of three clinical algorithms used to predict CBD stones. All patients undergoing first-time ERCP in 2011-2012 due to suspected CBD stones were enrolled prospectively in a clinical database. Data such as imaging test findings, liver function tests (LFTs) were collected 48h prior to and on the day of ERCP. Patients were stratified into different risk groups for harboring CBD stones according to three clinical algorithms employing imaging and laboratory data. Findings on ERCP were used as gold standard. The performance characteristics of each algorithm were separately calculated for each time point of LFT assessment. Overall, 186 patients were analyzed, 75% of who presented CBD stones on ERCP. The proportion of patients categorized as high-risk for harboring CBD stones varied among the three algorithms (67% vs. 73% vs. 56%). Also, the algorithms showed only moderate, albeit comparable, accuracy for predicting the presence of CBD stones (0.65, 95% confidence interval (CI) 0.62-0.68 vs. 0.68, 95%CI 0.63-0.67 vs. 0.59, 95%CI 0.57-0.61). Similar results were obtained when performance characteristics were recalculated using LFTs from 48h prior to ERCP (data not shown). Three diagnostic algorithms commonly used for predicting CBD stones have comparable but only moderate accuracy. Further research is warranted to improve risk stratification of patients with suspected CBD stones. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Citation

Mohamed Ebrahim, Lars Tue Sorensen, Lars Nannestad Jorgensen, Evangelos Kalaitzakis. Current clinical algorithms for predicting common bile duct stones have only moderate accuracy. Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society. 2017 Dec 01

PMID: 29194774

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