Endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis: From guidelines to clinical practice

Table 1 Baseline characteristics of the study population n (%)

Variable	Total (n= 268)
Gender, female	161 (60.1)
Age, mean ± SD	66.8 ± 16.8
Very strong predictors
Clinical ascending cholangitis	36 (13.4)
Common bile duct stone on US	109 (40.7)
Total bilirubin > 4 mg/dL	102 (38.1)
Strong predictors
Total bilirubin 1.8-4 mg/dL	84 (31.3)
Dilated common bile duct on US	195 (72.8)
Moderate predictors
Abnormal liver function test	231 (86.2)
Age > 55 yr	197 (73.5)
Gallstone pancreatitis	63 (23.5)

US: Ultrasonography.

Table 2 Predictors of choledocholithiasis - univariate analysis n (%)

Variable	Choledocholithiasis on ERCP	No Choledocholithiasis on ERCP	OR	95%CI	Pvalue
Very strong predictors
Clinical ascending cholangitis	33 (91.7)	3 (8.3)	6.48	1.93-21.80	0.001
Common bile duct stone on US	100 (91.7)	9 (8.3)	11.25	5.32-23.81	< 0.001
Total bilirubin > 4 mg/dL	76 (74.5)	26 (25.5)	1.79	1.04-3.08	0.035
Strong predictors
Total bilirubin 1.8-4 mg/dL	63 (75.0)	21 (25.0)	3.15	1.63-6.08	0.001
Dilated common bile duct on US	150 (76.9)	45 (23.1)	5.06	2.85-8.99	< 0.001
Moderate predictors
Abnormal liver function test	161 (69.7)	70 (30.3)	2.43	1.20-4.90	0.012
Age > 55 yr	142 (72.1)	55 (27.9)	2.37	1.36-4.15	0.002
Gallstone pancreatitis	36 (57.2)	27 (42.8)	0.58	0.32-1.03	0.063

ERCP: Endoscopic retrograde cholangiopancreatography; US: Ultrasonography.

Table 3 Risk group for choledocholithiasis - univariate analysis n (%)

Variable	Total	Choledocholithiasis on ERCP	No Choledocholithiasis on ERCP	Pvalue
High risk group	193 (72.0)	154 (79.8)	39 (20.2)	< 0.001
Intermediate risk group	73 (27.2)	25 (34.2)	48 (65.8)
Low risk group	2 (0.8)	0 (0)	2 (100)
Very strong predictors
None	97 (36.2)	39 (40.2)	58 (59.8)	< 0.001
One	104 (38.8)	80 (76.9)	24 (23.1)
Two	58 (21.6)	51 (87.9)	7 (12.1)
Three	9 (3.4)	9 (100)	0 (0)
Strong predictors
None	27 (16.4)	3 (11.1)	24 (88.9)	< 0.001
One	78 (47.3)	50 (64.1)	28 (35.9)
Two	60 (36.4)	50 (83.3)	10 (16.7)

ERCP: Endoscopic retrograde cholangiopancreatography.

Table 4 Sensitivity, specificity, positive predictive values and negative predictive values for choledocolithiasis

Variable	Sensitivity	Specificity	PPV	NPV
Very strong predictors
Clinical ascending cholangitis	18.4	96.6	91.7	37.0
Common bile duct stone on US	55.9	89.9	91.7	50.3
Total bilirubin > 4 mg/dL	42.5	70.8	74.5	37.8
Strong predictors
Total bilirubin 1.8-4 mg/dL	61.1	66.6	75	51.2
Dilated common bile duct on US	83.8	49.4	76.9	60.3
Moderate predictors
Abnormal liver function test	89.9	21.3	69.7	51.3
Age > 55 yr	79.3	38.2	72.1	47.9
Gallstone pancreatitis	20.1	69.7	57.1	30.2
High risk group	86	56.2	79.8	66.7
Intermediate risk group	13.9	46	34,2	21

PPV: Positive predictive values; NPV: Negative predictive values; US: Ultrasonography.