Predictive Factors for Choledocholithiasis in Symptomatic Gallstone Patients
Vichit Viriyaroj MD*, Thammanij Rookkachart MD*
Affiliation : * Department of Surgery, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
Background : Complications of common bile duct stones (choledocholithiasis) can vary from simple biliary colic to life-
threatening conditions. Approximately 10-25% of symptomatic gallstone patients may be associated common bile duct
stone (CBDS) at the time of diagnosis. Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard for
diagnosis and treatment of CBDS but this procedure is invasive and has high morbidity and mortality rate. Moreover, routine
preoperative ERCP is not cost-effectiveness.
Objective : This study aimed to determine the predictive factors for predicting CBDS in symptomatic gallstone patients.
Material and Method: Between March 2008 and February 2011, 149 symptomatic gallstone patients who underwent
preoperative ERCP or intraoperative cholangiography (IOC) during laparoscopic cholecystectomy at Her Royal Highness
Princess Mahachakri Sirindorn Medical Center (MSMC) were evaluated by clinical presentations, biochemical blood test
and transabdominal ultrasonography. The preoperative predictive factors for choledocholithiasis were determined by univariate
and multivariate analysis.
Results : Age morethan 55 years, history of jaundice, history of cholangitis, total bilirubin >2.0 mg/dL, Aspartate
aminotransferase >2 times the normal value, Alanine aminotransferase >3 times the normal value, Alkaline phosphatase
>300 U/L, Gamma glutamyltranspeptidase >90 U/L, sized of CBD >8 mm and visualized CBD stones by ultrasonography
were found to be associated with CBD stones by univariate analysis. For multivariate analysis, history of cholangitis (p-value
0.027), sized of CBD >8 mm (p-value 0.003) and detected CBD stones by ultrasonography (p-value 0.000) were found to be
predictive factors for choledocholithiasis.
Conclusion : This study presented that the helpful preoperative predictive factors for choledocholithiasis were history of
cholangitis, dilatation of CBD >8 mm and visualized CBD stone by ultrasonography.
Keywords : Predictive factors, Choledocholithiasis, Gall stone, Common bile duct stone
