Department of Surgery, Pattani Hospital, Pattani, Thailand.
Center for Clinical Epidemiology & Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
PLoS One. 2023 Mar 16;18(3):e0282899. doi: 10.1371/journal.pone.0282899. eCollection 2023.
To develop a simplified scoring system for clinical prediction of difficulty in CBD stone removal to assist endoscopists working in resource-limited settings in deciding whether to proceed with an intervention or refer patients to a center capable of performing additional procedures and interventions.
This study included patients with CBD stones who underwent ERCP at Pattani Hospital between August 2017 and December 2021. Retrospective cohort data was collected and patients were categorized into two groups: bile duct stones successfully treated by endoscopic biliary sphincterotomy and extraction compared to the former method combined with EPLBD. We explored potential predictors using multivariable logistic regression. The chosen logistic coefficients were transformed into a scoring system based on risk with internal validation via bootstrapping procedure.
Among the 155 patients who had successful endoscopic therapy for bile duct stones, there were 79 (50.97%) cases of endoscopic biliary sphincterotomy, EPLBD and extraction versus 76 (49.03%) cases without EPLBD. The factors used to derive a scoring system included the size of CBD stones >15 mm, the difference between the stone and distal CBD diameter >2mm, distal CBD arm length <36 mm and stone shape. The score-based model's area under ROC was 0.88 (95% CI: 0.83, 0.93). For clinical use, the range of scores from 0 to 16, was divided into two subcategories based on CBD stone removal difficulty requiring EPLBD to derive the PPV. For scores <5 and ≥ 5, the PPV was 23.40 (p <0.001) and 93.44 (p <0.001) respectively. The Bootstrap sampling method indicated a prediction ability of 0.88 (AuROC, 95% CI: 0.83, 0.94).
This scoring system has acceptable prediction performance in assisting endoscopists in their choice of stone removal procedure.
为了开发一种简化的 CBD 结石取石困难的临床预测评分系统，以帮助资源有限环境下的内镜医生决定是否进行干预，或将患者转介至能够进行额外手术和干预的中心。
本研究纳入了 2017 年 8 月至 2021 年 12 月期间在帕塔尼医院接受 ERCP 的 CBD 结石患者。回顾性收集队列数据，并将患者分为两组：内镜下胆管括约肌切开取石术成功治疗的胆管结石与前者联合 EPLBD 治疗的胆管结石。我们使用多变量逻辑回归探索潜在的预测因素。选择的逻辑系数基于风险转化为评分系统，通过自举程序进行内部验证。
在 155 例成功内镜治疗胆管结石的患者中，有 79 例（50.97%）行内镜下胆管括约肌切开取石术、EPLBD 和取石术，76 例（49.03%）未行 EPLBD。用于推导评分系统的因素包括 CBD 结石大小>15mm、结石与远端 CBD 直径差>2mm、远端 CBD 臂长<36mm 和结石形状。基于评分的模型 ROC 曲线下面积为 0.88（95%CI：0.83，0.93）。为了临床应用，将 0 至 16 分的评分范围分为两组，根据需要 EPLBD 以获得阳性预测值（PPV）来确定 CBD 结石清除难度。对于<5 分和≥5 分的评分，PPV 分别为 23.40（p<0.001）和 93.44（p<0.001）。Bootstrap 抽样法表明，该评分系统具有 0.88（AuROC，95%CI：0.83，0.94）的预测能力。
该评分系统在协助内镜医生选择结石清除术方面具有可接受的预测性能。
