Predictive Factors For Choledocholithiasis In Patient Undergoing Cholecystectomy in Ibn Sina Specialized Hospital From 1/1/2019 - 1/1/2020

  • Mohammed Adel Hamad Sudan Medical Specialized Board
  • Abdelmajed Mohamed Mussad Faculty of Medicine, Omdurman Islamic University, Sudan
  • Nassir Alhaboob Arabi Faculty of Medicine, Omdurman Islamic University, Sudan


Background:Choledocholithiasis constitutes the main aetiology of non-malignant biliary obstructions. The prevalence of CBD stones in patients with symptomatic gallstones varies but probably lies between 8 % and 20%. Failure to detect CBD stones leads to potentially life-threatening complications such as cholangitis, pancreatitis or obstructive jaundice. ERCP, MRCP and Intraoperative cholangiography have high sensitivity in detecting CBDS but its routine use is associated with increased complications, costs and operating room time. In this study we felt a need for useful predictive factors to predict patients having choledocholithiasis so that these modern interventions can be selectively utilized, and to determine the patients who need CBD exploration during cholecystectomy. Patient and Methods :Data was collected from consecutive patients diagnosed with cholelithiasis and choledocholithiasis by clinical presentations, ultrasonography and liver function tests at Ibn Sena Hospital, then CBD stone confirmed by  definitive testing for choledocholithiasis ( ERCP, MRCP or common bile duct [CBD] exploration). These clinical, biochemical and radiological findings were considered as predictive factors and analysed retrospectively. Results:A total of 72 patiens satisfied our inclusion criteria. Of those, 86% (n=62) had CBD stone, and 14% (n=10) did not have CBD stone. Several variables were analysed and showed that total bilirubin, ALP, AST, ALT, dilated CBD>6mm and visible CBD stone on ultrasonography were significantly associated with choledocholithiasis (p<0.05). Then four predictive factors (total bilirubin, ALP, dilated CBD > 6mm and visible CBDS on ultrasonography )  were used to build a simple scoring system. Conclusion:our results showed that abnormal liver function tests, multiple gallbladder stones, dilated CBD more than 6mm and visible CBD stone in ultrasonographic were statistically significant for detection of choledocholithiasis. Also we suggest a simple scoring system as a predictor for CBD stones.


1. Tozatti J, Mello AL, Frazon O. Predictor factors for choledocholithiasis. Arq Bras Cir Dig. 2015; 28:109–1.
2. Japan gallstone study group. J Jpn Biliary Assoc 1998; 12: 276e293.
3. Valdivieso V, Covarrubias C, Siegel F et al. Pregnancy and cholelithiasis: pathogenesis and natural course of gallstones diagnosed in early puerperium. Hepatology 1993; 17: 1e4.
4. Maringhini A, Ciambra M, Baccelliere P et al. Biliary sludge and gallstones in pregnancy: incidence, risk factors, and natural history. Ann Intern Med 1993; 119: 116e120.
5. Barbara L, Sama C, Morselli-Labate AM et al. A population study on the prevalence of gallstone disease: the Sirmione study. Hepatology 1987; 7: 913e919.
6. The Rome Group for Epidemiology and Prevention of Cholelithiasis (GREPCO). The epidemiology of gallstone disease in Rome, Italy. Part I. Prevalence data in men. Hepatology 1988; 8: 904e906.
7. Robert Memba, Sergio Gonz_alez, Daniel Coronado, Ver_onica Gonz_alez, Fernando Mata, Jos_e Antonio Rodrı´guez, Carlos Mu¨ hlenberg, Joan Sala, Ruth Ribas, Eva Pueyo, Alfredo Mata, Donal B. O'Connor, Kevin C. Conlon, Rosa Jorba. Single-stage approach for the management of choledocolithiasis with concomitant cholelithiasis. Implementation of a protocol in a secondary hospital Surgeon.2019 Jan 28. Pii:s1479-666x(18)30144-6.
8. Freeman ML (2012) Complications of endoscopic retrograde
9. cholangiopancreatography. Tech Gastrointest Endosc 14(3):148–155.
10. Anderson MA, Fisher L, Jain R, Evans JA, Appalaneni V, Ben-
11. Menachem T, Cash BD, Decker GA, Early DS, Fanelli RD, Fisher DA, Fukami N, Hwang JH, Ikenberry SO, Jue TL, Khan KM, Krinsky ML, Malpas PM, Maple JT, Sharaf RN, Shergill AK, Dominitz JA (2012) Complications of ERCP. Gastrointest Endosc 75(3):467–473.
12. Freitas ML , Bell RL, Duffy AJ. Choledocholithiasis: Evolving standards for diagnosis and management World J Gastroenterol. 2006 May 28;12(20):3162-7.
13. Abboud PA, Malet PF, Berlin JA, Staroscik R, Cabana MD, Clarke JR, Shea JA, Schwartz JS, Williams SV. Predictors of common bile duct stones prior to cholecystectomy: a metaanalysis. Gastrointest Endosc 1996; 44: 450-455.
14. Barkun AN, Barkun JS, Fried GM, Ghitulescu G, Steinmetz O, Pham C Meakins JL, Goresky CA. Useful predictors of bile duct stones in patients undergoing laparoscopic cholecystectomy. McGill Gallstone Treatment Group. Ann Surg 1994; 220: 32-39.
15. Cohen ME, Slezak L, Wells CK, Andersen DK, Topazian M. Prediction of bile duct stones and complications in gallstone pancreatitis using early laboratory trends. Am J Gastroenterol 2001; 96: 3305-3311.
16. Ahmed R, Duncan MD. The Management of common bile duct stones. In: Cameron JL, Cameron AM, eds. Current Surgical Therapy. Elsevier Inc. Philadelphia. PA; 2014. pp. 391-5.
17. Shojaiefard A, Esmaeilzadeh M, Ghafouri A, Mehrabi A. Various
18. Techniques for the surgical treatment of common bile duct stones: a Meta review. Gastroenterol Res Pract. 2009;2009:840208.
19. Kessler RE, Falkenstein DB, Clemett AR, Zimmon DS. Indications, clinical value and complications of endoscopic retrograde cholangiopancreatography. Surg Gynecol Obstet. 1976;142:865–70.
20. Sethi S, Wang F, Korson AS, et al. Prospective assessment of consensus criteria for evaluation of patients with suspected choledocholithiasis. Dig Endosc 2015; 28: 75–82.
21. Williams EJ, Green J, Beckingham I, et al. Guidelines on the management of common bile duct stones (CBDS). Gut 2008; 57: 1004 1021.
22. Kamath SU , Dharap SB , Kumar V. Scoring system to preoperatively predict choledocholithiasis Indian J Gastroenterol. 2016 May;35(3):173-8.
23. Al-Jiffry BO , Khayat S, Abdeen E, Hussain T, Yassin M. A scoring system for the prediction of choledocholithiasis: a prospective cohort study Ann Saudi Med. 2016 Jan-Feb;36(1):57-63.
24. Kadah A1, Khoury T2, Mahamid M3, Assy N4, Sbeit W1.Predicting common bile duct stones by non-invasive parameters.Hepatobiliary Pancreat Dis Int. 2019 Nov 20. pii: S1499-3872(19)30221-8.
25. Aleknaite A, Simutis G, Stanaitis J, Valantinas J, Strupas K. Risk assessment of choledocholithiasis prior to laparoscopic cholecystectomy and its management options. United European Gastroenterol J. 2018 Apr;6(3):428-438.
26. Grande M, Torquati A, Tucci G, Rulli F, Adorisio O, Farinon AM. Preoperative risk factors for common bile duct stones: defining the patient at high risk in the laparoscopic cholecystectomy era. J Laparoendosc Adv Surg Tech A. 2004 Oct;14(5):281-6.
27. Prat F , Meduri B , Ducot B , Chiche R , Salimbeni-Bartolini R , Pelletier G . Prediction of common bile duct stones by noninvasive tests. Ann Surg 1999;229:362–368.
28. Adams MA, Hosmer AE, Wamsteker EJ. Predicting the likelihood of a persistent bile duct stone in patients with suspected choledocholithiasis: accuracy of existing guidelines and the impact of laboratory trends. Gastrointest Endosc 2015;82:88-93.
29. He H1, Tan C1, Wu J1, Dai N1, Hu W1, Zhang Y1, Laine L2, Scheiman J3, Kim JJ4. Accuracy of ASGE high-risk criteria in evaluation of patients with suspected common bile duct stones.Gastrointest Endosc. 2017 Sep;86(3):525-532.
30. Sethi S, Wang F, Korson AS, Krishnan S, Berzin TM, Chuttani R, Pleskow DK, Sawhney MS. Prospective assessment of consensus criteria for evaluation of patients with suspected choledocholithiasis. Dig Endosc. 2016 Jan;28(1):75-82.
31. Nárvaez Rivera RM , González González JA , Monreal Robles R , García Com- pean D , Paz Delgadillo J , Garza Galindo AA , et al. Accuracy of ASGE criteria for the prediction of choledocholithiasis. Rev Esp Enferm Dig 2016;108:309–314.
32. Videhult P, Sandblom G, Rudberg C, Rasmussen IC. Are liver function tests, pancreatitis and cholecystitis predictors of common bile duct stones? Results of a prospective, population-based, cohort study of 1171 patients undergoing cholecystectomy. HPB (Oxford). 2011;13:519–27.
33. Yang MH1, Chen TH, Wang SE, Tsai YF, Su CH, Wu CW, Lui WY, Shyr YM.Biochemical predictors for absence of common bile duct stones in patients undergoing laparoscopic cholecystectomy.Surg Endosc. 2008 Jul;22(7):1620-4. Epub 2007 Nov 14.
34. Peng WK, Sheikh Z, Paterson-Brown S, Nixon SJ. Role of liver function tests in predicting common bile duct stones in acute calculous cholecystitis. Br J Surg. 2005 Oct;92(10):1241-7.
35. Suarez AL , LaBarre NT , Cotton PB , Payne KM , Coté GA , Elmunzer BJ. An assessment of existing risk stratification guidelines for the evaluation of patients with suspected choledocholithiasis. Surg Endosc 2016;30:4613–4618.
36. Zare M, Kargar S, Akhondi M, et al. Role of liver function enzymes in diagnosis of choledocholithiasis in biliary colic patients. Acta Med Iran 2011; 49: 663-666.
37. Kuzu UB1, Odemiş B2, Dişibeyaz S2, Parlak E2, Oztaş E2, Saygılı F2, Yıldız H2, Kaplan M2, Coskun O2, Aksoy A2, Arı D2, Suna N2, Kayaçetin E2.Management of suspected common bile duct stone: diagnostic yield of current guidelines.HPB (Oxford). 2017 Feb;19(2):126-132.
38. Sousa M, Pinho R, Proenca L, Rodriques J, Silva J, Comes C, Carvalho J.ASGE high-risk criteria for choledocholithiasis - Are they applicable in cholecystectomized patients?.Dig Liver Dis. 2019 Jan;51(1):75-78.
39. Menezes N, Marson LP, Debeaux AC, Muir IM, Auld CD. Prospective analysis of a scoring system to predict choledocholithiasis. Br J Surg. 2000;87:1176–81.
40. Sherman JL, Shi EW, Ranasinghe NE, Sivasankaran MT, Prigoff JG, Divino CM. Validation and improvement of a proposed scoring system to detect retained common bile duct stones in gallstone pancreatitis. Surgery. 2015 Jun;157(6):1073-9.
How to Cite
HAMAD, Mohammed Adel; MUSSAD, Abdelmajed Mohamed; ARABI, Nassir Alhaboob. Predictive Factors For Choledocholithiasis In Patient Undergoing Cholecystectomy in Ibn Sina Specialized Hospital From 1/1/2019 - 1/1/2020. Gezira Journal of Health Sciences, [S.l.], v. 16, n. 1, p. 77-94, sep. 2020. ISSN 1810-5386. Available at: <>. Date accessed: 21 oct. 2020.