Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 26, 2020; 8(8): 1414-1423
Published online Apr 26, 2020. doi: 10.12998/wjcc.v8.i8.1414
Bedside score predicting retained common bile duct stone in acute biliary pancreatitis
Tawfik Khoury, Anas Kadah, Mahmud Mahamid, Amir Mari, Wisam Sbeit
Tawfik Khoury, Anas Kadah, Mahmud Mahamid, Amir Mari, Wisam Sbeit, Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
Tawfik Khoury, Anas Kadah, Wisam Sbeit, Department of Gastroenterology, Galilee Medical Center, Nahariya 22100, Israel
Tawfik Khoury, Mahmud Mahamid, Amir Mari, Gastroenterology and endoscopy units, The Nazareth Hospital EMMS, Nazareth 16100, Israel
Author contributions: Khoury T and Sbeit W contributed to conception and design of the study; Khoury T, Kadah A, Mahamid M, Mari A and Sbeit W contributed to data collection and analysis; Khoury T and Sbeit W contributed to critical revision of the manuscript; Khoury T, Kadah A, Mahamid M, Mari A and Sbeit W approved the final version to be published.
Institutional review board statement: The study was approved by the local ethical committee, number 0189-17-NHR.
Informed consent statement: Written informed consent was waived by the IRB due to the retrospective, non-interventional nature of the study.
Conflict-of-interest statement: The authors declare no conflict of interest regarding this manuscript.
Data sharing statement: Statistical code and dataset available from the corresponding author at (tawfikk@gmc.gov.il). Consent was not obtained for data sharing but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Tawfik Khoury, MD, Doctor, Lecturer, Senior Researcher, Department of Gastroenterology, Galilee Medical Center, POB 12000, Naharia 2210001, Israel. tawfikkhoury1@hotmail.com
Received: December 15, 2019
Peer-review started: December 15, 2019
First decision: January 7, 2020
Revised: March 3, 2020
Accepted: April 15, 2020
Article in press: April 15, 2020
Published online: April 26, 2020
Processing time: 128 Days and 18.2 Hours
Abstract
BACKGROUND

Retained common bile duct (CBD) stone after an acute episode of biliary pancreatitis is of paramount importance since stone extraction is mandatory.

AIM

To generate a simple non-invasive score to predict the presence of CBD stone in patients with biliary pancreatitis.

METHODS

We performed a retrospective study including patients with a diagnosis of biliary pancreatitis. One hundred and fifty-four patients were included. Thirty-three patients (21.5%) were diagnosed with CBD stone by endoscopic ultrasound (US).

RESULTS

In univariate analysis, age (OR: 1.048, P = 0.0004), aspartate transaminase (OR: 1.002, P = 0.0015), alkaline phosphatase (OR: 1.005, P = 0.0005), gamma-glutamyl transferase (OR: 1.003, P = 0.0002) and CBD width by US (OR: 1.187, P = 0.0445) were associated with CBD stone. In multivariate analysis, three parameters were identified to predict CBD stone; age (OR: 1.062, P = 0.0005), gamma-glutamyl transferase level (OR: 1.003, P = 0.0003) and dilated CBD (OR: 3.685, P = 0.027), with area under the curve of 0.8433. We developed a diagnostic score that included the three significant parameters on multivariate analysis, with assignment of weights for each variable according to the co-efficient estimate. A score that ranges from 51.28 to 73.7 has a very high specificity (90%-100%) for CBD stones, while a low score that ranges from 9.16 to 41.04 has a high sensitivity (82%-100%). By performing internal validation, the negative predictive value of the low score group was 93%.

CONCLUSION

We recommend incorporating this score as an aid for stratifying patients with acute biliary pancreatitis into low or high probability for the presence of CBD stone.

Keywords: Stones; Common bile duct; Predictors; Biliary; Pancreatitis

Core tip: Approximately 20%-30% of patients with acute biliary pancreatitis will retain their common bile duct (CBD) stone. Early identification of these patients is critical since stone extraction is mandatory. We performed a single center retrospective study including 154 patients who were followed for simple clinical, laboratory and radiological parameters. We generated a simple diagnostic score including 3 variables (age, gamma-glutamyl transferase level and CBD width by ultrasound) with excellent diagnostic performance and capability of stratifying patients into low or high risk for retained CBD stone.