[Evaluation of probability of bile duct stone presence by using of non-invasive procedures].
Precise evaluation of bile duct stones presence in particular moment, performed using the most non-invasive method, is important for the planning of optimal treatment. Not only simple imaging procedures (like conventional transabdominal ultrasound--US) but also more sophisticated imaging methods (CT or MRI) are frequently useless. The "gold standards" of bile duct stones diagnosis are still endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy and surgical choledochotomy. However, the ERCP expose the patients to the risk of some serious complications. The aim of the study was to evaluate the diagnostic capabilities of patients case history data and non-invasive tests (such as biochemistry, ultrasound data) in order to establish a risk scale in cases suspected for common bile duct stones. The investigated group comprised of 135 patients treated from January 1996 through March 1997 in the Department of Gastroenterology Silesian Medical Academy. In patients prospectively enrolled to the study case history and a set of blood biochemical examinations were completed. In following, US was performed. The verification of the biliary tree (done with ERCP with endoscopic sphincterotomy or surgical choledochotomy) was performed. Examiners (US, ERCP) were blind to the other results of a patient. Case history data, laboratory blood tests and US results were used to select parameters significantly differing between patients with and without bile duct stones. Thirteen parameters were tested using Mann-Whitney's and chi 2 tests and four parameters were finally selected. For every selected parameter cut off values (i.e. values best differentiating patients with and without stones) were chosen on the basis of the chi 2 value, 95% confidence interval of risk ratio and Youden's index (gamma-GTP, alanine transaminase, enlarged bile ducts on US, bile duct stones on US). In the next step a set of different combinations of selected parameters was tested to find out the best waged scale for bile duct stones risk diagnosis. Finally, diagnostic efficacy of the best constructed scales and US alone were compared. Constructed risk scales can not be employed in the primary selection of patients, as their positive predictive value is quite high, but negative predictive value is low. US is also not valuable in evaluation of patients suspected for common bile duct stones.
Kohut
Maciej
M
Katedra i Klinika Gastroenterologii Sl. AM w Katowicach. Maciej.2250177@pharmanet.com.pl
Nowak
Andrzej
A
Marek
Tomasz
T
Błaszczyńska
Małgorzata
M
Bołdys
Hubert
H
Sliwiński
Zbigniew
Z
Hartleb
Marek
M
D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D002769:Cholelithiasis / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011336:Probability; D011446:Prospective Studies