Prediction of common bile duct stones in the earliest stages of acute biliary pancreatitis

H. C. van Santvoort; O. J. Bakker; M. G. Besselink; T. L. Bollen; K. Fischer; V. B. Nieuwenhuijs; H. G. Gooszen; K. J. Erpecum

doi:10.1055/s-0030-1255866

Endoscopy 2011; 43(1): 8-13
DOI: 10.1055/s-0030-1255866

Original article

Prediction of common bile duct stones in the earliest stages of acute biliary pancreatitis

H. C. van Santvoort¹ , O. J. Bakker¹ , M. G. Besselink¹ , T. L. Bollen² , K. Fischer³ , V. B. Nieuwenhuijs⁴ , H. G. Gooszen⁵ , K. J. Erpecum⁶ , for the members of the Dutch Pancreatitis Study Group

¹Department of Surgery, University Medical Center Utrecht, The Netherlands
²Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
³Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
⁴Department of Surgery, University Medical Center Groningen, The Netherlands
⁵Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
⁶Department of Gastroenterology, University Medical Center Utrecht, The Netherlands

Abstract

Background and study aims: Accurate prediction of common bile duct (CBD) stones in acute biliary pancreatitis is warranted to select patients for early therapeutic endoscopic retrograde cholangiopancreatography (ERCP). We evaluated commonly used biochemical and radiological predictors of CBD stones in a large prospective cohort of patients with acute biliary pancreatitis who were undergoing early ERCP.

Patients and methods: 167 patients with acute biliary pancreatitis who were undergoing early ERCP (< 72 hours after symptom onset) in 15 Dutch hospitals in 2004 – 2007 were prospectively included. Abdominal ultrasonography and/or computed tomography (CT) was performed on admission and complete liver biochemistry determined daily. We used univariate logistic regression to assess associations between CBD stones found during ERCP (gold standard) and the following parameters: (1) clinical: age, sex, predicted severity; (2) radiological: dilated CBD, impacted stone in CBD; and (3) biochemical: bilirubin, γ-glutamyltransferase (GGT), alkaline phosphatase, alanine aminotransferase (ALT), and aspartate aminotransferase (AST).

Results: Out of 167 patients, 94 (56 %) had predicted severe acute biliary pancreatitis, 51 (31 %) exhibited a dilated CBD and 15 (9 %) had CBD stones on ultrasonography and/or CT. ERCP was performed at a median of 0 days (interquartile range 0 – 1) after admission. CBD stones were found during ERCP in 89/167 patients (53 %). In univariate analysis, the only parameters significantly associated with CBD stones were GGT (per 10 units increase: odds ratio 1.02, 95 % CI 1.01 – 1.03, P = 0.001) and alkaline phosphatase (per 10 units increase: odds ratio 1.03, 95 % CI 1.00 – 1.05, P = 0.028). These and all other tested parameters, however, showed poor positive predictive value (ranging from 0.53 to 0.69) and poor negative predictive value (ranging from 0.46 to 0.67).

Conclusions: The results of this study suggest that commonly used biochemical and radiological predictors of the presence of CBD stones during ERCP in the earliest stages of acute biliary pancreatitis are unreliable.

Full Text

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K. J. van ErpecumMD, PhD

Department of Gastroenterology F.02.618
University Medical Center Utrecht

P.O. Box 85500
3508 GA Utrecht
The Netherlands

Fax: +31-88-7555533

Email: k.j.vanerpecum@umcutrecht.nl