Ali Imdad, Taha Yaseen Raja, Ahmed Khan Shoaib, Tasneem Abbas Ali, Laeeq Syed Mudassir, Ismail Hina, Hassan Luck Nasir
Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, PAK.
Department of Gastroenterology, Sindh Institute of Urology and Transplantation, Karachi, PAK.
Cureus. 2023 Jul 25;15(7):e42445. doi: 10.7759/cureus.42445. eCollection 2023 Jul.
Background and aim The role of expensive, risky, and unnecessary endoscopic interventions can be avoided by the use of non-invasive tests to predict common bile duct (CBD) stones. Therefore, our aim was to identify non-invasive predictors of choledocholithiasis (CL) in patients and further to predict a model and assess its diagnostic accuracy in predicting CL. Methods This cross-sectional study was carried out from June 1, 2020, to December 31, 2021. Patients having gall bladder stones on percutaneous transabdominal sonography and fulfilling intermediate probability criteria of CL were enrolled. These patients then underwent radial endoscopic ultrasound (EUS) followed by endoscopic retrograde cholangiopancreatography (ERCP) for detecting CBD stones. Univariate logistic regression analysis, followed by multivariate logistic regression analysis, was performed to ascertain the independent predictors of CBD stone in patients with intermediate probability. A model was proposed, and the diagnostic accuracy was calculated at an optimal cutoff. The model was then internally validated in the patients with intermediate probability and was also compared with the pre-existing score. Results Out of 131 patients included in the study, CBD stone was noted in 85 (66%) and 88 (67.2%) patients on EUS and ERCP, respectively. On multivariate analysis, high serum bilirubin (>2 mg/dL) and alkaline phosphatase (200 IU) and dilated CBD (>6 mm) on transabdominal sonography at baseline were significant predictors of CBD stone in these patients. Using these variables, a scoring system (BATS score) was developed, which had an area under the receiver operating curve (AUROC) of 0.98 in predicting the presence of CBD stone with a sensitivity of 93.18%, a specificity of 76.74%, and a diagnostic accuracy of 87.79%. In the validation cohort, a BATS score of ≥5 had a diagnostic accuracy of 95.91% in predicting CL. Conclusion The BATS score showed excellent sensitivity and good diagnostic accuracy in predicting the CBD stone with excellent results on internal validation. However, external validation of our results is required to recommend this model on a larger scale.
背景与目的 通过使用非侵入性检查来预测胆总管（CBD）结石，可以避免昂贵、有风险且不必要的内镜干预。因此，我们的目的是确定患者胆总管结石（CL）的非侵入性预测指标，并进一步预测一个模型并评估其在预测CL方面的诊断准确性。方法 本横断面研究于2020年6月1日至2021年12月31日进行。纳入经皮经腹超声检查发现有胆囊结石且符合CL中间概率标准的患者。这些患者随后接受径向内镜超声（EUS）检查，然后进行内镜逆行胰胆管造影（ERCP）以检测CBD结石。进行单因素逻辑回归分析，随后进行多因素逻辑回归分析，以确定中间概率患者中CBD结石的独立预测指标。提出一个模型，并在最佳截断值处计算诊断准确性。然后在中间概率患者中对该模型进行内部验证，并与现有的评分进行比较。结果 在纳入研究的131例患者中，EUS和ERCP分别发现85例（66%）和88例（67.2%）患者有CBD结石。多因素分析显示，基线时血清总胆红素>2mg/dL、碱性磷酸酶>200IU以及经腹超声检查发现CBD扩张>6mm是这些患者CBD结石的显著预测指标。利用这些变量，开发了一个评分系统（BATS评分），其在预测CBD结石存在时的受试者操作特征曲线下面积（AUROC）为0.98，灵敏度为93.18%，特异度为76.74%，诊断准确性为87.79%。在验证队列中，BATS评分≥5在预测CL时的诊断准确性为95.91%。结论 BATS评分在预测CBD结石方面显示出优异的灵敏度和良好的诊断准确性，内部验证结果良好。然而，需要对我们的结果进行外部验证，以便在更大范围内推荐该模型。
