Menezes et al developed a score for predicting choledocholithiasis in a patient about to undergo laparoscopic cholecystectomy. This can help to identify a patient who may benefit from ERCP prior to surgery. The authors are from King's College Hospital in London.
Parameters:
(1) gender of the patient
(2) age of the patient in years
(3) jaundice
(4) ascending cholangitis
(5) serum transaminase (AST, ALT) levels
(6) common bile duct diameter on ultrasonography
(7) common bile duct stone on ultrasonography
|
Parameter |
Finding |
Points |
|
gender of the patient |
female |
0 |
|
|
male |
1 |
|
age of the patient |
< 55 years of age |
0 |
|
|
>= 55 years of age |
1 |
|
jaundice |
none |
0 |
|
|
resolved |
1 |
|
|
present |
2 |
|
ascending cholangitis |
no |
0 |
|
|
yes |
3 |
|
serum transaminases |
normal |
0 |
|
|
1.01 to 1.99 times ULN |
2 |
|
|
>= 2.0 times ULN |
4 |
|
common bile duct diameter |
normal |
0 |
|
|
dilated |
3 |
|
common bile duct stone(s) |
none |
0 |
|
|
1 or more |
3 |
where:
• ULN = upper limit of the normal reference range
• CBD = common bile duct
• ERCP = endoscopic retrograde cholangiopancreatography
• The spreadsheet will use ALT levels for serum transaminases.
• The cutoff diameter of the common bile duct on ultrasonography was not stated. A diameter > 6 mm was used by Barkun et al (above).
score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: 0
• maximum score: 17
• A score >= 3 was used to identify a patient who should undergo ERCP prior to laparoscopic cholecystectomy with cholangiography.
• A patient with a score of 0 to 2 should have the laparoscopic cholecystectomy with cholangiography without the ERCP.
Performance:
• The sensitivity of the score at the cutoff was 82% and the specificity 80%.
Specialty: Gastroenterology, Surgery, general
ICD-10: ,
