Reddy Siddhartha, Jagtap Nitin, Kalapala Rakesh, Ramchandani Mohan, Lakhtakia Sundeep, Basha Jahangeer, Nabi Zaheer, Karyampudi Arun, Chavan Radhika, Tandan Manu, Gupta Rajesh, Reddy D Nageshwar
Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India (Siddhartha Reddy, Nitin Jagtap, Rakesh Kalapala, Mohan Ramchandani, Sundeep Lakhtakia, Jahangeer Basha, Zaheer Nabi, Arun Karyampudi, Radhika Chavan, Manu Tandan, Rajesh Gupta, D. Nageshwar Reddy).
Ann Gastroenterol. 2021;34(2):247-252. doi: 10.20524/aog.2020.0562. Epub 2020 Dec 7.
Acute calculous cholecystitis (ACC) is the most frequent complication of gallstones requiring cholecystectomy. These patients may have coexisting choledocholithiasis. We aimed to evaluate the role of current guidelines for choledocholithiasis in patients with ACC.
In this retrospective study, we included all patients diagnosed with ACC between December 2018 and May 2019. These patients were substratified according to the guidelines of the American and European Societies of Gastrointestinal Endoscopy (ASGE and ESGE) as having high, intermediate, or low likelihood of choledocholithiasis, and the diagnostic performance was measured. Binomial logistic regression analysis was applied to ascertain independent risk factors for choledocholithiasis.
A total of 173 patients with ACC, mean age (±standard deviation) 49.89±15.74 years and 60.1% male, were included. Sixty-three (36.4%) had confirmed choledocholithiasis. ASGE high likelihood criteria had sensitivity and specificity of 61.9% (95% confidence interval [CI] 48.8-73.9) and 83.4% (95%CI 75.4-90.0) for predicting choledocholithiasis. ESGE high likelihood criteria had sensitivity and specificity of 49.2% (95%CI 36.4-62.1) and 87.3% (95%CI 79.6-92.9). On logistic regression analysis, an alkaline phosphatase level above the upper limit of normal (P=0.003; odds ratio [OR] 4.26, 95%CI 1.66-10.96) and a dilated common bile duct on ultrasound (P=0.001; OR 9.97, 95%CI 4.65-21.36) were independent positive predictors for choledocholithiasis, while acute biliary pancreatitis was an independent negative predictor (P=0.030; OR 0.36, 95%CI 0.14-0.91).
The performance of the ASGE and ESGE guidelines' risk stratification criteria is inadequate in patients with ACC. We suggest the utilization of a separate predictive model for suspected choledocholithiasis in these patients.
急性结石性胆囊炎（ACC）是需要进行胆囊切除术的胆结石最常见的并发症。这些患者可能并存胆总管结石。我们旨在评估当前胆总管结石指南在ACC患者中的作用。
在这项回顾性研究中，我们纳入了2018年12月至2019年5月期间所有诊断为ACC的患者。根据美国和欧洲胃肠内镜学会（ASGE和ESGE）的指南，将这些患者分为胆总管结石可能性高、中或低的亚组，并测量诊断性能。应用二项逻辑回归分析确定胆总管结石的独立危险因素。
共纳入173例ACC患者，平均年龄（±标准差）为49.89±15.74岁，男性占60.1%。63例（36.4%）确诊为胆总管结石。ASGE高可能性标准预测胆总管结石的敏感性和特异性分别为61.9%（95%置信区间[CI]48.8-73.9）和83.4%（95%CI 75.4-90.0）。ESGE高可能性标准的敏感性和特异性分别为49.2%（95%CI 36.4-62.1）和87.3%（95%CI 79.6-92.9）。逻辑回归分析显示，碱性磷酸酶水平高于正常上限（P=0.003；比值比[OR]4.26，95%CI 1.66-10.96）和超声显示胆总管扩张（P=0.001；OR 9.97，95%CI 4.65-21.36）是胆总管结石的独立阳性预测因素，而急性胆源性胰腺炎是独立的阴性预测因素（P=0.030；OR 0.36，95%CI 0.14-0.91）。
ASGE和ESGE指南的风险分层标准在ACC患者中的表现不足。我们建议对这些患者疑似胆总管结石采用单独的预测模型。
