Usman Qureshi, Muhammad Hanif, Naeem Zia, Naveed Malik, Umer Farooq, Muhammad Mussadiq Khan.
Pre Operative Assessment of Risk of Common Bile Duct Stones. Retrospective Analysis of a Scoring System.
J Rawal Med Coll Jan ;5(1):16-21.

Thirty three patients of cholelithiasis, with definite documentation of the presence (n=21) or absence (n=12) of common bile duct stones on ERCP were studied. They were graded according to a specific scoring system, initially devised by a U.K. study group, which incorporated clinical presentation, liver function tests and abdominal ultrasound findings. The requisite information was recorded on a specifically designed proforma. Scores were calculated for each patient and compared with the findings of ERCP regarding presence or absence of common bile duct (CBD) stones. A score of 3 or more was taken as predictive for CBD stones. Our study showed a sensitivity of 90% with a high negative predictive value of 81% the false negative results being only 6%. Specificity was 75%, with a good positive predictive value of 86% and false positive results only 9%. We feel this scoring system increases the accuracy of CBD stone detection, thereby rationalising the number of patients undergoing ERCP. A procedure, which with its attendant morbidity and occasional mortality may be thus avoided. The scoring system is simple and is recommended for the preoperative selection of patients for ERCP.

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