Trend in predictive factors of choledocholithiasis: the key to the management of pediatric patients with suspected gallstones.

M A Capparelli, S Canestrari, R Ortiz, P D D'Alessandro, V H Ayarzabal, M E Barrenechea
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Abstract

Objectives: To reduce the overuse of magnetic resonance cholangiopancreatography and the rates of non-therapeutic endoscopic retrograde cholangiopancreatography in pediatric patients suspected of choledocholithiasis.

Materials and methods: Retrospective study of patients suspected of choledocholithiasis between January 2010 and June 2023. Patients with cholangitis or two or more of the following predictive factors of choledocholithiasis in initial laboratory tests and ultrasound were categorized as high-risk group: total bilirubin level ≥ 2 mg/dl, common bile duct > 6 millimeters on ultrasound; and detection of choledocholithiasis by ultrasound. Patients were recategorized according to the results of the second set of laboratory and ultrasound analysis. Confirmatory modalities (magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography, and/or intraoperative cholangiography) were used to evaluate the presence of choledocholithiasis. Finally, we assessed the predictive capability of both the initial high-risk group and the group after recategorization.

Results: A total of 129 patients were included. After initial studies, 72 (55.8%) patients were classified into the high-risk group. After recategorization, only 29 (22.5%) patients were included in this group. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of the initial high-risk group were 89.3%, 53.5%, 34.7%, 94.7%, and 61.2%, respectively, while after recategorization, they were 82.1%, 94.1%, 79.3%, 95.0%, and 91.5%, respectively.

Conclusions: Recategorization of the risk of choledocholithiasis would significantly improve the diagnostic accuracy of choledocholithiasis and help reduce the overuse of more complex and unnecessary studies/procedures.

胆石症预测因素的趋势:处理疑似胆结石儿科患者的关键。
目的减少儿童胆总管结石疑似患者过度使用磁共振胰胆管造影术和非治疗性内镜逆行胰胆管造影术的比例:2010年1月至2023年6月期间疑似胆总管结石患者的回顾性研究。将患有胆管炎或在最初的实验室检查和超声波检查中具有以下两种或两种以上胆总管结石预测因素的患者归为高风险组:总胆红素水平≥ 2 mg/dl,超声波检查总胆管> 6 mm,超声波检查发现胆总管结石。根据第二套实验室和超声波分析结果对患者进行重新分类。确诊方式(磁共振胰胆管造影、内镜逆行胰胆管造影和/或术中胆管造影)用于评估是否存在胆总管结石。最后,我们评估了初始高风险组和重新分类后的高风险组的预测能力:共纳入了 129 名患者。经过初步研究,72 例(55.8%)患者被归入高风险组。重新分类后,只有 29 名(22.5%)患者被归入该组。初始高风险组的灵敏度、特异性、阳性预测值、阴性预测值和诊断准确率分别为 89.3%、53.5%、34.7%、94.7% 和 61.2%,而重新分类后分别为 82.1%、94.1%、79.3%、95.0% 和 91.5%:结论:对胆总管结石风险进行重新分类将大大提高胆总管结石诊断的准确性,并有助于减少过度使用更复杂和不必要的检查/手术。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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