Prediction of choledocholithiasis by non-invasive testings. Review

The incidence of common bile duct (CBD) calculi has been reported to be 8 % to 20 % among patients with cholelithiasis. Failure to detect CBD calculi on the part of the surgeon subjects patients to potentially life­threatening complications such as cholangitis, pancreatitis or obstructive jaundice. Modalities for detection of CBD calculi were as follows: intraoperative cholangiography, endoscopic retrograde cholangiopancreaticography and, recently, magnetic resonance cholangiopancreaticography and endoscopic ultrasonography. The expensive, risky, and unnecessary endoscopic interventions can be avoided by the use of non­invasive tests to predict common bile duct calculi. Objective — to assess the performance of different clinical parameters in predicting CBD calculi. Materials and methods. A search of the electronic databases MEDLINE, Scopus, and Google Scholar from 2019 until August 2024 was conducted to identify studies reporting non­invasive prognostic testigns for choledocholithiasis. Results. Numerous models have been developed to predict choledocholithiasis. The American Society of Gastrointestinal Endoscopy (ASGE), Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and the European Society of Gastrointestinal Endoscopy (ESGE) have published guidelines for choledocholithiasis. However, the guidelines were formulated using data from a large number of patients with a low risk of CBD stones. High risk criteria of SAGES, ASGE and ESGE have excellent accuracy in predicting CBD calculi whereas intermediate risk and light risk criteria are suboptimal for excluding CBD calculi. The BATS (bilirubin, alkaline phosphatase, dilatation of CBD) core showed excellent sensitivity and good diagnostic accuracy in predicting the CBD calculi with excellent results on internal validation. A scoring system based on three parameters (alkaline phosphatase, gamma­glutamyl transferase and total bilirubin) was developed to predict the presence of a CBD calculi in patients meeting intermediate probability criteria according to ASGE guidelines with a diagnostic accuracy of 87.3 %. However, these recommendations for choledocholithiasis risk stratification criteria are not effective enough for patients with acute cholecystitis. Therefore, Israel’s scоre was proposed to predict common bile duct calculi in these patients. Conclusions. External validation of research findings is needed to recommend these models on a larger scale.