title: Biochemical and ultrasound parameters may help predict the need for therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in patients with a firm clinical and biochemical suspicion for choledocholithiasis.
abstract: BACKGROUND
  Prediction of the need for therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in patients with suspected choledocholithiasis (CDL) remains a challenging task.
  
  
  OBJECTIVE
  We aimed to evaluate the predictive value of biochemical and ultrasound parameters and to create a corresponding model for prediction of the need for therapeutic ERCP.
  
  
  METHODS
  203 consecutive patients referred to our center due to a firm clinical and/or biochemical suspicion for CDL. All patients underwent ERCP. Biochemical and ultrasound variables were analyzed.
  
  
  RESULTS
  The sample was divided into testing group (103; 50.7%) and validation group (100; 49.3%) which did not differ in their baseline characteristics. Elevated gamma glutamil transaminase (GGT), common bile duct (CBD) diameter and presence of hyperechoic structures in CBD were found to be significant predictors for presence of CBD stones on ERCP (p<0.05) in the testing group. We used these variables to construct a predictive model for the presence of CBD stones on ERCP. The model was tested on a second, validation group of patients using ROC analysis with the area under the ROC curve of 0.81 (%95 CI=0.75-0.86; p<0.001). We identified a threshold (0.86) above which, patients had a high probability (93.1%) for the need for interventional ERCP.
  
  
  CONCLUSIONS
  Our predictive model may help predict the need for therapeutic ERCP in patients with a suspicion for choledocholithiasis.
authors.affiliation: University Clinical Center Tuzla, Department of Gastroenterology, Tuzla, Bosnia and Herzegovina. prredo@yahoo.com
authors.forename: Predrag
authors.initials: P
authors.lastname: Jovanović
authors.forename: Nermin N
authors.initials: NN
authors.lastname: Salkić
authors.forename: Enver
authors.initials: E
authors.lastname: Zerem
authors.forename: Farid
authors.initials: F
authors.lastname: Ljuca
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D042883:Choledocholithiasis / Q000097:blood* / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods* / Q000592:standards; D055815:Young Adult
chemical_list: D015415:Biomarkers