담관담석의 평가와 처치, Evaluation and management of choledocholithiasis

The American Society for Gastrointestinal Endoscopy (ASGE)는 담도담석이 있을 확률에 근거하여 환자 처치를 결정하는 다음과 같은 접근법을 제안했습니다. ​ Very strong predictors만 외워 두고 여기에 해당하지 않으면 거의 intermediate에 해당되고 필요한 검사는 EUS 또는 MRCP입니다. Less invasive options for detecting choledocholithiasis include EUS and MRCP. Deciding which test should be performed first depends on various factors such as ease of availability, cost, patient-related factors, and the suspicion for a small stone "Very strong" predictors 1) The presence of a common bile duct stone on transabdominal ultrasound 2) Clinical acute cholangitis 3) A serum bilirubin greater than 4 mg/dL ​ "Strong" predictors 1) A dilated common bile duct on ultrasound (more than 6 mm in a patient with a gallbladder in situ) 2) A serum bilirubin of 1.8 to 4 mg/dL (31 to 68 micromol/L) ​ "Moderate" predictors 1) Abnormal liver biochemical test other than bilirubin 2) Age older than 55 years 3) Clinical gallstone pancreatitis ​ Using the above predictors, patients are stratified as: High risk 1) At least one very strong predictor and/or 2) Both strong predictors ​ Intermediate risk 1) One strong predictor and/or 2) At least one moderate predictor ​ Low risk 1)No predictors Flow chart for the evaluation and management of choledocholithiasis CBD: common bile duct; ERCP: endoscopic retrograde cholangiopancreatography; EUS: endoscopic ultrasound; IOC: intraoperative cholangiogram; MRCP: magnetic resonance cholangiopancreatography. Reproduced from: ASGE Standards of Practice Committee. The role of endoscopy in the evaluation of suspected choledocholithiasis. Gastrointest Endosc 2010; 71:1. ​ ​ REF 1. https://www.gie.or.kr/pds/quiz.php   ​ 2. UpToDate 2020.08.07