Predictive model of persistent choledocholithiasis in patients with acute biliary pancreatitis.

Autor:	Mínguez A; Gastroenterology Department, Digestive Medicine Service, La Fe University and Polytechnic Hospital, Valencia, Spain., Ladrón P; Gastroenterology Department, Digestive Medicine Service, La Fe University and Polytechnic Hospital, Valencia, Spain., Martínez S; Gastroenterology Department, Digestive Medicine Service, La Fe University and Polytechnic Hospital, Valencia, Spain., Del Val A; Gastroenterology Department, Digestive Medicine Service, La Fe University and Polytechnic Hospital, Valencia, Spain., Nos P; Gastroenterology Department, Digestive Medicine Service, La Fe University and Polytechnic Hospital, Valencia, Spain; Networked Biomedical Research Center for Hepatic and Digestive Diseases (CIBEREHD), Institute of Health Carlos III, 28029 Madrid, Spain., de-Madaria E; Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain; Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche, Spain. Electronic address: emadaria@umh.es.
Jazyk:	English; Spanish; Castilian
Zdroj:	Gastroenterologia y hepatologia [Gastroenterol Hepatol] 2023 Apr; Vol. 46 (4), pp. 297-304. Date of Electronic Publication: 2022 Oct 13.
DOI:	10.1016/j.gastrohep.2022.10.006
Abstrakt:	Background: Choledocholithiasis causing acute biliary pancreatitis (ABP) may migrate to the duodenum or persist in the common bile duct (CBD). We developed a model for predicting persistent choledocholithiasis (PC) in patients with ABP. Methods: This retrospective cohort study included 204 patients, age ≥18 years (mean age: 73 years, 65.7% women), admitted for ABP in 2013-2018, with at least a magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasonography (EUS), and/or endoscopic retrograde cholangiopancreatography (ERCP). Epidemiological, analytical, imaging, and endoscopic variables were compared between patients with and without PC. Multivariate logistic regression analyses were performed to develop a predictive model of PC. Results: Patients underwent MRCP (n=145, 71.1), MRCP and ERCP (n=44, 21.56%), EUS and ERCP (n=1, 0.49%), or ERCP (n=14, 6.86%). PC was detected in 49 patients (24%). PC was strongly associated with CBD dilation, detected in the emergency ultrasound (p<0.001; OR=27; 95% CI: 5.8-185.5), increased blood levels of gamma glutamyl transpeptidase, detected at 72h (p=0.008; OR=3.4; 95% CI: 1.5-8.9); and biliary sludge in the gallbladder (p=0.008; OR=0.03; 95% CI: 0.001-0.3). Conclusions: The predictive model showed a validated area under the curve (AUC) of 0.858 for detecting PC in patients with ABP. A nomogram was developed based on model results. Conclusions: The predictive model was highly effective in detecting PC in patients with ABP. Therefore, this model could be useful in clinical practice. (Copyright © 2022 Elsevier España, S.L.U. All rights reserved.)
Databáze:	MEDLINE
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