Acta Medica Leopoliensia (Sep 2020)

Aspects of diagnosis and treatment of oligosymptomatic choledocholithiasis in patients with acute calculous cholecystitis

  • V.I. Kolomiytsev,
  • O.V. Lukavetskiy,
  • O.M. Terletskiy

DOI
https://doi.org/10.25040/aml2020.02-03.049
Journal volume & issue
Vol. 26, no. 2-3
pp. 49 – 54

Abstract

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Aim. Developing optimal approaches in the diagnostic algorithm and treatment of patients with acute calculous cholecystitis complicated by oligosymptomatic choledocholithiasis. Material and Methods. The results of treatment of 215 patients with acute calculous cholecystitis complicated by oligosymptomatic choledocholithiasis were analyzed, 166 of which-were studied retrospectively, and 49 - prospectively. Female patients predominated (74.0%); the average age was 56.0±1.06 years. Blood serum biochemistry, transabdominal ultrasound, magnetic resonance cholangiopancreatography, and blood and bile microRNA were used for the diagnosis. Results and Discussion. After verification of the diagnosis by applying several tests and developed multivariate models based on determining the blood and bile microRNA, and the model consisting of 5 factors for the prediction of the presence of choledocholithiasis (alkaline phosphatase, AST, ALT, total bilirubin, the common bile duct diameter according to transabdominal ultrasound), the main therapeutic option to resolve biliary duct problems in 183 (85.1%) patients were endoscopic retrograde cholangiography (ERC) with sphincterotomy and stone extraction. In the second step, 159 (74.0%) patients underwent laparoscopic cholecystectomy. One-step interventions (laparoscopic cholecystectomy and stones removal / intraoperative therapeutic ERC) due to association with acute cholecystitis changes in the hepatoduodenal ligament were performed on 7 (3.3%) patients only. Conclusions. In patients with acute calculous cholecystitis, using a 5-factor model has a fairly high prognostic value for the prediction of choledocholithiasis, and the additional use of quantifying the expression levels of miRNA-122 and miRNA-21 significantly improves the diagnosis of asymptomatic choledocholithiasis. The optimal approach to the treatment of such patients is to perform therapeutic ERCP followed by laparoscopic cholecystectomy.

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