Raja Taha Yaseen Khan*, Adeel ur Rehman, Muhammad Manzoor ul Haque, Abbas Ali Tasneem, Farina M Hanif, Syed Mudassir Laeeq and Nasir Hassan Luck
Department of Gastroenterology and Hepatology, Sindh Institute of Urology and Transplantation, PakistanFulltext PDF
Background: Data is scarce regarding validation of intermediate probability of CBD stone. Previously, studies have validated laboratory investigations like GGT or ALP individually to be helpful in the diagnosis of CBD stone. However, no score has been predicted up to date which has collectively included all these parameters. The aim of our study was to identify the non-invasive risk
factors for detection of CBD stone and also, to compute a score and then to evaluate the diagnosticaccuracy of this score in prediction of Choledocholithiasis (CL).
Methods: It was a cross-sectional prospective study which was conducted over a period of one year (January 2018 to December 2018). All patients falling in intermediate probability criteria for CBD stone were included in the study and subsequently underwent Endoscopic Ultrasound (EUS) prior to ERCP. AGT score was formulated as a noninvasive predictor for CBD stone for each individual as (ALP+GGT)/(T.B). Finally, the sensitivity, specificity, PPV, NPV and diagnostic accuracy was calculated for the AGT score for the prediction of CBD stone.
Results: A total of seventy-one patients who were suspected for CBD stone as per intermediate probability criteria were enrolled in our study. The Mean age was 52.9+11.9 years and there were 42 (59.1%) males. Sixty-six (92.9%) patients presented with abdominal pain while five patients (7%) had gall stone pancreatitis. On Endoscopic Ultrasound (EUS), choledocholithiasis was observed in 49 (68.1%) patients while on ERCP, CBD stone was seen in 47 (66.2%) patients.
On comparative analysis, noninvasive laboratory investigations such as Total Leukocyte Count, Alkaline Phosphatase and Gamma Glutamyl Transferase were significantly higher in patients with CBD stone as compared to those without stone (8.16 vs. 6.96 and p=0.015) for TLC, (394 vs. 229, p ≤ 0.001 and 349 vs. 254, p=0.05) for Alkaline phosphatase and GGT respectively. There
was a significant association of higher AGT score with presence of CBD stone with a p-value of ≤ 0.001. AUROC for AGT score was 0.837. At a cut-off value of ≥ 463 for AGT score in predicting choledocholithiasis, the sensitivity of the score was of 93.18%, specificity of 77.78%, NPV of 87.5%, PPV of 87.2% and diagnostic accuracy of 87.3%.
Conclusion: We have developed a scoring system (AGT score) based on three parameters (ALK P, GGT and Total Bilirubin) to predict the presence of CBD stone in patients falling in intermediate probability criteria according to ASGE guidelines with a diagnostic accuracy of 87.3%. However, in future more data and studies are required to validate this score.
CBD stone; Intermediate probability criteria; Predictor of choledocholithiasis; AGT score
Khan RTY, ur Rehman A, ul Haque MM, Ali Tasneem A, Hanif FM, Laeeq SM, et al. AGT Score as a Predictor of
Common Bile Duct Stone in Patients with Intermediate Probability Criteria According to ASGE Guidelines. J Gastroenterol Hepatol Endosc. 2021;6(3): 1101..