Benites Goñi Harold Eduardo, Palacios Salas Fernando Vicente, Asencios Cusihuallpa Jairo Luis, Aguilar Morocco Rossmery, Segovia Valle Nasthya Solange
Servicio de Gastroenterología, Hospital Nacional Edgardo Rebagliati Martins. Lima, Perú.
Departamento de Aparato Digestivo, Hospital Nacional Edgardo Rebagliati Martins. Lima, Perú.
Rev Gastroenterol Peru. 2017 Apr-Jun;37(2):111-119.
In Peru, there are still no local studies designed for evaluating the performance of clinical guidelines designed to stratify patients according to probability of choledocholithiasis.
To evaluate the performance of predictive criteria proposed by the American Society for Gastrointestinal Endoscopy (ASGE) in diagnosis of choledocholithiasis.
A retrospective cohort study conducted in a hospital in Lima (Rebagliati hospital). Were included all patients with suspected choledocholithiasis who underwent endoscopic retrograde cholangiopancreatography (ERCP) between July 2014 and June 2015. Predictors of choledocholithiasis proposed by the ASGE and the diagnostic performance of the risk categories were evaluated.
118 patients met the inclusion criteria. In multivariate analysis, only age >55 years (OR: 3.07 [95: 1.14-8.31], p = 0.027) and the finding of stones in the common bile duct by abdominal ultrasound (OR: 1.68 [95% CI: 1.09-2.59], p = 0.018) were associated with the presence of choledocholithiasis on ERCP. The performance of the high and intermediate risk categories were 75.82% and 70.37% respectively. The performance of the high-risk category improved to 85.90% using a second set of biochemical markers.
The performance of the predictors and risk categories proposed by the ASGE in diagnosis of choledocholithiasis is acceptable in our hospital, according to the proposed standards; however, it must be further improved to prevent the use of diagnostic ERCP.
在秘鲁，仍没有专门用于评估旨在根据胆总管结石病概率对患者进行分层的临床指南性能的本地研究。
评估美国胃肠内镜学会（ASGE）提出的预测标准在胆总管结石病诊断中的性能。
在利马的一家医院（雷瓦利亚蒂医院）进行了一项回顾性队列研究。纳入了2014年7月至2015年6月期间所有接受内镜逆行胰胆管造影（ERCP）的疑似胆总管结石病患者。评估了ASGE提出的胆总管结石病预测指标以及风险类别的诊断性能。
118例患者符合纳入标准。多因素分析显示，只有年龄>55岁（OR：3.07 [95%：1.14 - 8.31]，p = 0.027）和腹部超声发现胆总管结石（OR：1.68 [95%CI：1.09 - 2.59]，p = 0.018）与ERCP检查时胆总管结石的存在相关。高风险和中风险类别的性能分别为75.82%和70.37%。使用第二组生化标志物后，高风险类别的性能提高到了85.90%。
根据所提出的标准，ASGE提出的预测指标和风险类别在我院诊断胆总管结石病中的性能是可以接受的；然而，必须进一步改进以避免使用诊断性ERCP。
