Imaging-independent model for predicting choledocholithiasis in acute biliary pancreatitis

doi:10.4240/wjgs.125793

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Surg. Nov 27, 2026; 18(11): 125793
Published online Nov 27, 2026. doi: 10.4240/wjgs.125793

Table 1 Baseline characteristics, n (%)

	No CBD stone	CBD stone	P value
Patients	181 (100)	167 (100)
Sex			> 0.9
Female	92 (51)	86 (51)
Male	89 (49)	81 (49)
Age, median (IQR: Q1, Q3)	62 (45, 74)	68 (54, 80)	< 0.001
BMI (kg/m²), median (IQR: Q1, Q3)	27.7 (24.5, 32.2)	26.3 (24.0, 30.6)	0.13
Unknown, n	40	28
Concrement localization			< 0.001
CBD	0 (0)	74 (44)
CBD + GB	0 (0)	93 (56)
CBD width (mm), median (IQR: Q1, Q3)	6.0 (5.0, 8.0)	10.0 (8.2, 12.0)	< 0.001
Unknown, n	27	8
Laboratory values at admission
Bilirubin (mg/dL), median (IQR: Q1, Q3)	1.60 (0.90, 3.45)	2.60 (1.40, 4.90)	0.001
Bilirubin unknown	1	1
AP (U/L), median (IQR: Q1, Q3)	134 (91, 203)	190 (117, 290)	< 0.001
AP unknown	3	4
GGT (U/L), median (IQR: Q1, Q3)	283 (119, 500)	373 (196, 646)	< 0.001
GGT unknown	1	4
ICU stay	9 (5.0)	22 (13)	0.007
Severity (RAC)			0.5
Mild	96 (55)	80 (48)
Moderate	62 (35)	65 (39)
Severe	18 (10)	20 (12)
Unknown	5	2
Comorbidities
None	70 (38.7)	41 (24.6)
Cholecystectomy	1 (0.6)	22 (13.2)	< 0.001
Gastritis/reflux	17 (9.4)	15 (9.0)
Liver disease	10 (5.5)	15 (9.0)
Cardiac disease	47 (26.0)	44 (26.3)
Carcinoma in history/current	20 (11.0)	26 (15.6)
Upper GI tract surgery	7 (3.9)	5 (3.0)
Dyslipidemia	31 (17.1)	22 (13.2)
Diabetes mellitus II	26 (14.4)	28 (16.7)
Arterial hypertension	76 (42.0)	91 (54.5)
Medication on admission
None	76 (42.0)	46 (27.5)
PPI	38 (21.9)	49 (29.3)
Antihypertensive drugs	72 (40.0)	91 (54.5)
Lipid lowering drugs	32 (17.7)	37 (22.2)
Diuretics	20 (11.0)	30 (18.0)
Analgesics	5 (2.8)	5 (3.0)
Pancreatic enzymes	0 (0.0)	1 (0.6)
UDCA	1 (0.6)	2 (1.2)
Immunosuppressant drugs	8 (4.4)	11 (6.6)
Unknown	9 (5.0)	8 (4.8)

P values were determined using Wilcoxon rank sum test for numerical features and Pearson’s χ² test for categorical features. Continuous variables as median (IQR: Q1, Q3), categorical as n (%). P values are descriptive and were not used for predictor selection. Comorbidity and medication categories are not mutually exclusive. CBD: Common bile duct; BMI: Body mass index; PPI: Proton-pump inhibitors; UDCA: Ursodeoxycholic acid; GI: Gastrointestinal; GB: Gall bladder; IQR: Interquartile range; AP: Alkalic phosphatase; GGT: Gamma-glutamyl transferase; ICU: Intensive care unit; RAC: Revised Atlanta Classification.

Full Size Table

Table 2 Performance of different models in predicting intraductal concrements (values in square brackets represent 95% confidence interval)

	CBD width (≥ 8 mm)	Bilirubin (≥ 4 mg/dL)	CBD + bilirubin	RF model
Sensitivity	0.795 (0.645; 0.892)	0.308 (0.186; 0.464)	0.256 (0.146; 0.411)	0.923 (0.797; 0.973)
Specificity	0.548 (0.378; 0.708)	0.774 (0.602; 0.886)	0.903 (0.751; 0.967)	0.355 (0.211; 0.531)
PPV	0.689 (0.543; 0.805)	0.632 (0.410; 0.809)	0.769 (0.497; 0.918)	0.643 (0.512; 0.755)
NPV	0.680 (0.484; 0.828)	0.471 (0.341; 0.605)	0.491 (0.366; 0.617)	0.786 (0.524; 0.924)
Correct rule-out (true negative), n (%)	17 (24.29)	24 (34.29)	28 (40.00)	11 (15.71)
False rule-out (missed IDCs), n (%)	8 (11.43)	27 (38.57)	29 (41.43)	3 (4.29)
Accuracy	0.686 (0.570; 0.782)	0.514 (0.400; 0.628)	0.543 (0.427; 0.654)	0.671 (0.555; 0.770)

IDC: Intraductal concrements; CBD: Common bile duct; PPV: Positive predictive value; NPV: Negative predictive value; RF: Random forest.

Full Size Table

Citation: Sirtl S, Schäfer APG, Bretthauer K, Hohmann E, Junge M, Ahmad M, Vielhauer J, Hausdorf A, Hubert MO, Velamazán R, Aghamaliyev U, Schirra J, Schulz C, Żorniak M, Beyer G, Mahajan UM, Mayerle J, Stubbe HC. Imaging-independent model for predicting choledocholithiasis in acute biliary pancreatitis. World J Gastrointest Surg 2026; 18(11): 125793
URL: https://www.wjgnet.com/1948-9366/full/v18/i11/125793.htm
DOI: https://dx.doi.org/10.4240/wjgs.125793

Sirtl S, Schäfer APG, Bretthauer K, Hohmann E, Junge M, Ahmad M, Vielhauer J, Hausdorf A, Hubert MO, Velamazán R, Aghamaliyev U, Schirra J, Schulz C, Żorniak M, Beyer G, Mahajan UM, Mayerle J, Stubbe HC. Imaging-independent model for predicting choledocholithiasis in acute biliary pancreatitis. World J Gastrointest Surg 2026; 18(11): 125793 [DOI: 10.4240/wjgs.125793]

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