Might be over-evaluated: Predicting choledocholithiasis in patients with acute biliary pancreatitis.

Aykut Çelik, Cemalettin Ertekin, Leman Damla Ercan, İrem Gider, Feza Ekiz, Mehmet İlhan, Hakan Yanar, Mustafa Kayıhan Günay, Ali Fuat Kaan Gök
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Abstract

Background: The increase in liver cholestasis enzyme and bilirubin levels, especially due to pancreatitis, mimics choledocholithiasis. This study aimed to examine the relationship between demographic and laboratory cut-off values and the presence of choledocholithiasis in patients with acute biliary pancreatitis (ABP).

Methods: Patients diagnosed with ABP in the Department of General Surgery at Istanbul Faculty of Medicine between January 2010 and December 2022 were retrospectively analyzed. The presence of stones in the common bile duct was determined based on the results of magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasound (EUS), and endoscopic retrograde cholangiopancreatography (ERCP). Demographic and laboratory values of patients with and without bile duct stones were compared. Cut-off values were determined using receiver operating characteristic (ROC) curve analysis, and logistic regression analysis and modeling was performed for each variable.

Results: A total of 1,026 ABP patients were evaluated. Patients whose enzyme levels were not elevated and those who did not undergo MRCP were excluded. A total of 584 patients were included in the study, and choledocholithiasis was detected in 188 (32.2%) patients. In multivariate analysis, age, gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), and direct bilirubin (DB) were found to be statistically associated with choledocholithiasis. The cut-off values were determined as 65 years for age, 394 U/L for GGT, 173 U/L for ALP, and 1.42 mg/dL for direct bilirubin. In the group where all four parameters were below these cut-off values, suggesting a clean common bile duct, it was observed that the negative predictive value was 97%.

Conclusion: Based on the demographic and laboratory data of patients with ABP, we were able to predict with more than 97% accuracy that the common bile duct was clean. Considering that our study only included patients who underwent MRCP due to elevated enzyme levels and suspicion of choledocholithiasis, the negative predictive value would be even higher if patients with acute biliary pancreatitis with normal enzyme levels were included. Additionally, no complications were observed in any of the patients during follow-up. This finding suggests that patients whose common bile duct is predicted to be clean can initially be monitored and supported with additional imaging methods if necessary. As a result, unnecessary imaging can be avoided, reducing costs and preventing the mortality and morbidity associated with unnecessary procedures.

可能被高估:预测急性胆源性胰腺炎患者胆总管结石。
背景:肝脏胆汁淤积酶和胆红素水平的升高,尤其是胰腺炎引起的,与胆总管结石相似。本研究旨在探讨急性胆源性胰腺炎(ABP)患者的人口学和实验室临界值与胆总管结石之间的关系。方法:回顾性分析2010年1月至2022年12月伊斯坦布尔医学院普外科诊断为ABP的患者。根据磁共振胆管造影(MRCP)、内镜超声(EUS)和内镜逆行胆管造影(ERCP)的结果确定胆总管中是否存在结石。比较胆管结石患者和非胆管结石患者的人口学和实验室值。采用受试者工作特征(ROC)曲线分析确定截断值,并对各变量进行logistic回归分析和建模。结果:共评估1026例ABP患者。酶水平未升高和未接受MRCP的患者被排除在外。研究共纳入584例患者,其中188例(32.2%)患者检出胆总管结石。在多变量分析中,年龄、γ -谷氨酰转移酶(GGT)、碱性磷酸酶(ALP)和直接胆红素(DB)被发现与胆总管结石有统计学相关性。临界值确定为年龄65岁,GGT 394 U/L, ALP 173 U/L,直接胆红素1.42 mg/dL。在所有四个参数都低于这些临界值的组中,表明胆总管清洁,观察到阴性预测值为97%。结论:根据ABP患者的人口学和实验室数据,我们能够预测总胆管清洁的准确率超过97%。考虑到我们的研究只纳入了因酶水平升高和怀疑胆总管结石而行MRCP的患者,如果纳入酶水平正常的急性胆源性胰腺炎患者,阴性预测值会更高。此外,随访期间未见任何并发症。这一发现表明,预测胆总管清洁的患者可以在最初进行监测,并在必要时使用额外的成像方法。因此,可以避免不必要的成像,降低成本并防止与不必要的手术相关的死亡率和发病率。
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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