Gallstone Pancreatitis and Choledocholithiasis: Using Imaging and Laboratory Trends to Predict the Likelihood of Persistent Stones at Cholangiography

World J Surg. 2018 Oct;42(10):3143-3149. doi: 10.1007/s00268-018-4618-6.


Background: Patients with gallstone pancreatitis (GP) or choledocholithiasis (CDL) may have common bile duct (CBD) stones that persist until cholangiography. The aim of this study is to evaluate pre-cholangiogram factors that predict persistent CBD stones.

Methods: Multiple logistic regression analyses were performed to identify demographic, laboratory, and radiologic predictors of persistent CBD stones and non-therapeutic cholangiography among adults with GP or CDL.

Results: In 152 patients from 2010 to 2015, preoperative diagnosis, presence of a CBD stone on US, and age ≥ 60 years were associated with persistent CBD stones. Two risk factors alone had a PPV of 88% and the absence of all risk factors had a NPV of 94%. Age < 60 years and the absence of a CBD stone on US were most predictive of non-therapeutic cholangiography.

Conclusion: Age, LFTs, and US help predict persistent CBD stones in patients initially presenting with GP or CDL and help minimize non-therapeutic preoperative cholangiography.

MeSH terms

  • Adult
  • Aged
  • Cholangiography*
  • Choledocholithiasis / complications
  • Choledocholithiasis / diagnostic imaging*
  • Female
  • Gallstones / complications
  • Gallstones / diagnostic imaging*
  • Humans
  • Liver Function Tests
  • Male
  • Middle Aged
  • Pancreatitis / complications
  • Pancreatitis / diagnostic imaging*
  • Preoperative Period
  • Regression Analysis
  • Risk Factors
  • Treatment Outcome