Telem et al developed a score for predicting management of acute gallstone (biliary) pancreatitis. The score was validated by Sherman et al. The authors are from Mount Sinai Medical Center in New York.
Patient selection: acute biliary pancreatitis
Parameters:
(1) diameter of the common bile duct (CBD) in mm
(2) serum GGT in IU/L
(3) serum alkaline phosphatase in IU/L
(4) serum total bilirubin in mg/dL
(5) serum direct bilirubin in mg/dL
|
Parameter |
Finding |
Points |
|
diameter of CBD |
< 9 mm |
0 |
|
|
>= 9 mm |
1 |
|
serum GGT |
< 350 IU/L |
0 |
|
|
>= 350 IU/L |
1 |
|
serum alkaline phosphatase |
< 250 IU/L |
0 |
|
|
>= 250 IU/L |
1 |
|
serum total bilirubin |
< 3 mg/dL |
0 |
|
|
>= 3 mg/dL |
1 |
|
serum direct bilirubin |
< 2 mg/dL |
0 |
|
|
>= 2 mg/dL |
1 |
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 5
• The higher the score the greater the chance of having a common bile duct stone.
|
Score |
PPV for CBD Stones |
Management |
|
0 |
3% |
laparoscopic cholecystectomy with intraoperative cholangiogram |
|
1 |
15% |
laparoscopic cholecystectomy with intraoperative cholangiogram |
|
2 |
37% |
laparoscopic cholecystectomy with intraoperative cholangiogram |
|
3 |
75% |
magnetic resonance cholangio-pancreatography (MRCP) |
|
4 |
60% |
magnetic resonance cholangio-pancreatography (MRCP) |
|
5 |
100% |
endoscopic retrograde cholangio-pancreatography (ERCP) |
data from Sherman et al
Specialty: Gastroenterology
