University Clinical Center Tuzla, Department of Gastroenterology, Tuzla, Bosnia and Herzegovina.
Eur J Intern Med. 2011 Dec;22(6):e110-4. doi: 10.1016/j.ejim.2011.02.008. Epub 2011 Mar 5.
Prediction of the need for therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in patients with suspected choledocholithiasis (CDL) remains a challenging task.
We aimed to evaluate the predictive value of biochemical and ultrasound parameters and to create a corresponding model for prediction of the need for therapeutic ERCP.
203 consecutive patients referred to our center due to a firm clinical and/or biochemical suspicion for CDL. All patients underwent ERCP. Biochemical and ultrasound variables were analyzed.
The sample was divided into testing group (103; 50.7%) and validation group (100; 49.3%) which did not differ in their baseline characteristics. Elevated gamma glutamil transaminase (GGT), common bile duct (CBD) diameter and presence of hyperechoic structures in CBD were found to be significant predictors for presence of CBD stones on ERCP (p<0.05) in the testing group. We used these variables to construct a predictive model for the presence of CBD stones on ERCP. The model was tested on a second, validation group of patients using ROC analysis with the area under the ROC curve of 0.81 (%95 CI=0.75-0.86; p<0.001). We identified a threshold (0.86) above which, patients had a high probability (93.1%) for the need for interventional ERCP.
Our predictive model may help predict the need for therapeutic ERCP in patients with a suspicion for choledocholithiasis.
预测疑似胆总管结石（CDL）患者是否需要治疗性内镜逆行胰胆管造影术（ERCP）仍然是一项具有挑战性的任务。
我们旨在评估生化和超声参数的预测价值，并创建相应的模型来预测需要进行治疗性 ERCP。
203 例连续患者因临床和/或生化明确怀疑 CDL 而被转诊至我们中心。所有患者均接受 ERCP 检查。分析生化和超声变量。
样本被分为测试组（103 例；50.7%）和验证组（100 例；49.3%），两组在基线特征上没有差异。在测试组中，发现γ谷氨酰转移酶（GGT）升高、胆总管（CBD）直径和 CBD 内出现高回声结构是 ERCP 上 CBD 结石存在的显著预测因素（p<0.05）。我们使用这些变量构建了一个预测 ERCP 上 CBD 结石存在的模型。该模型在第二个验证组患者中使用 ROC 分析进行了测试，ROC 曲线下面积为 0.81（%95 CI=0.75-0.86；p<0.001）。我们确定了一个阈值（0.86），高于该阈值，患者进行介入性 ERCP 的可能性很高（93.1%）。
我们的预测模型可能有助于预测怀疑患有胆总管结石的患者是否需要治疗性 ERCP。
