{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:15:38Z","timestamp":1760148938050,"version":"build-2065373602"},"reference-count":26,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2023,6,20]],"date-time":"2023-06-20T00:00:00Z","timestamp":1687219200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>This study aimed to quantify the confirmation of gallstones on ultrasound (US) in patients with suspicion of gallstone disease. To aid general practitioners (GPs) in diagnostic workup, a model to predict gallstones was developed. A prospective cohort study was conducted in two Dutch general hospitals. Patients (\u226518 years) were eligible for inclusion when referred by GPs for US with suspicion of gallstones. The primary outcome was the confirmation of gallstones on US. A multivariable regression model was developed to predict the presence of gallstones. In total, 177 patients were referred with a clinical suspicion of gallstones. Gallstones were found in 64 of 177 patients (36.2%). Patients with gallstones reported higher pain scores (VAS 8.0 vs. 6.0, p &lt; 0.001), less frequent pain (21.9% vs. 54.9%, p &lt; 0.001), and more often met criteria for biliary colic (62.5% vs. 44.2%, p = 0.023). Predictors for the presence of gallstones were a higher pain score, frequency of pain less than weekly, biliary colic, and an absence of heartburn. The model showed good discrimination between patients with and without gallstones (C-statistic 0.73, range: 0.68\u20130.76). Clinical diagnosis of symptomatic gallstone disease is challenging. The model developed in this study may aid in the selection of patients for referral and improve treatment related outcomes.<\/jats:p>","DOI":"10.3390\/jcm12124162","type":"journal-article","created":{"date-parts":[[2023,6,21]],"date-time":"2023-06-21T02:01:33Z","timestamp":1687312893000},"page":"4162","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Patients with Clinically Suspected Gallstone Disease: A More Selective Ultrasound May Improve Treatment Related Outcomes"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1012-7991","authenticated-orcid":false,"given":"Floris M.","family":"Thunnissen","sequence":"first","affiliation":[{"name":"Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4336-1642","authenticated-orcid":false,"given":"Daan J.","family":"Comes","sequence":"additional","affiliation":[{"name":"Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4232-679X","authenticated-orcid":false,"given":"Remy W. F.","family":"Geenen","sequence":"additional","affiliation":[{"name":"Department of Radiology, Northwest Clinics, 1815 JD Alkmaar, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deniece","family":"Riviere","sequence":"additional","affiliation":[{"name":"Department of Radiology, Jeroen Bosch Hospital, 5223 GZ \u2018s-Hertogenbosch, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carmen S. S.","family":"Latenstein","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC, Location VUMC, 1081 HV Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3137-901X","authenticated-orcid":false,"given":"Marten A.","family":"Lantinga","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henk J.","family":"Schers","sequence":"additional","affiliation":[{"name":"Department of General Practice, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cornelis J. H. M.","family":"van Laarhoven","sequence":"additional","affiliation":[{"name":"Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joost P. H.","family":"Drenth","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Femke","family":"Atsma","sequence":"additional","affiliation":[{"name":"Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip R.","family":"de Reuver","sequence":"additional","affiliation":[{"name":"Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,6,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1016\/S0140-6736(06)69044-2","article-title":"Cholesterol gallstone disease","volume":"368","author":"Portincasa","year":"2006","journal-title":"Lancet"},{"key":"ref_2","unstructured":"Dutch Society of Surgery (2016). Dutch Society of Surgery Evidence-Based Guideline. Diagnostic and Treatment of Gallstones, Dutch Society of Surgery."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"European Association for the Study Of the Liver (2016). EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. J. Hepatol., 65, 146\u2013181.","DOI":"10.1016\/j.jhep.2016.03.005"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2368","DOI":"10.1007\/s00464-010-1268-7","article-title":"SAGES guidelines for the clinical application of laparoscopic biliary tract surgery","volume":"24","author":"Overby","year":"2010","journal-title":"Surg. Endosc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"16024","DOI":"10.1038\/nrdp.2016.24","article-title":"Gallstones","volume":"2","author":"Lammert","year":"2016","journal-title":"Nat. Rev. Dis. Prim."},{"key":"ref_6","unstructured":"(2023, June 01). Dutch Healthcare Authority: Data on Healthcare Utilization. Available online: https:\/\/www.opendisdata.nl\/."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1159\/000510503","article-title":"Hospital Variation in Cholecystectomies in The Netherlands: A Nationwide Observational Study","volume":"37","author":"Latenstein","year":"2020","journal-title":"Dig. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Rome Group for Epidemiology and Prevention of Cholelithiasis (GREPCO) (1988). The epidemiology of gallstone disease in Rome, Italy. Part II. Factors associated with the disease. The Rome Group for Epidemiology and Prevention of Cholelithiasis (GREPCO). Hepatology, 8, 907\u2013913.","DOI":"10.1002\/hep.1840080434"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2322","DOI":"10.1016\/S0140-6736(19)30941-9","article-title":"Restrictive strategy versus usual care for cholecystectomy in patients with gallstones and abdominal pain (SECURE): A multicentre, randomised, parallel-arm, non-inferiority trial","volume":"393","author":"Wennmacker","year":"2019","journal-title":"Lancet"},{"key":"ref_10","first-page":"e766","article-title":"Functional Dyspepsia and Irritable Bowel Syndrome are Highly Prevalent in Patients with Gallstones and are Negatively Associated with Outcomes After Cholecystectomy: A Prospective, Multicentre, Observational Study (PERFECT-Trial)","volume":"275","author":"Latenstein","year":"2020","journal-title":"Ann. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e053188","DOI":"10.1136\/bmjopen-2021-053188","article-title":"Healthcare utilisation of patients with cholecystolithiasis in primary care: A multipractice comparative analysis","volume":"11","author":"Thunnissen","year":"2021","journal-title":"BMJ Open"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1001\/jamainternmed.2014.6016","article-title":"Patients\u2019 expectations of the benefits and harms of treatments, screening, and tests: A systemat-ic review","volume":"175","author":"Hoffmann","year":"2015","journal-title":"JAMA Intern. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1080\/13814780600881300","article-title":"Yield of abdominal ultrasound in patients with abdominal pain referred by general practitioners","volume":"12","author":"Speets","year":"2006","journal-title":"Eur. J. Gen. Pr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"370","author":"Altman","year":"2007","journal-title":"Lancet"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1097\/00006676-199507000-00008","article-title":"Quality of life in chronic pancreatitis--results after duodenum-preserving resection of the head of the pancreas","volume":"11","author":"Bloechle","year":"1995","journal-title":"Pancreas"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2455","DOI":"10.1177\/0962280218784726","article-title":"Sample size for binary logistic prediction models: Beyond events per variable criteria","volume":"28","author":"Moons","year":"2019","journal-title":"Stat. Methods Med Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e213706","DOI":"10.1001\/jamasurg.2021.3706","article-title":"A Clinical Decision Tool for Selection of Patients With Symptomatic Cholelithiasis for Cholecystectomy Based on Reduction of Pain and a Pain-Free State Following Surgery","volume":"156","author":"Latenstein","year":"2021","journal-title":"JAMA Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1111\/sjos.12429","article-title":"Asymptotic theory and inference of predictive mean matching imputation using a superpopulation model framework","volume":"47","author":"Yang","year":"2019","journal-title":"Scand Stat. Theory Appl."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"m441","DOI":"10.1136\/bmj.m441","article-title":"Calculating the sample size required for developing a clinical prediction model","volume":"368","author":"Riley","year":"2020","journal-title":"BMJ"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Moons, K.G.M., de Groot, J.A.H., Bouwmeester, W., Vergouwe, Y., Mallett, S., Altman, D.G., Reitsma, J.B., and Collins, G.S. (2014). Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies: The CHARMS Checklist. PLoS Med., 11.","DOI":"10.1371\/journal.pmed.1001744"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1002\/sim.6782","article-title":"Review and evaluation of penalised regression methods for risk prediction in low-dimensional data with few events","volume":"35","author":"Pavlou","year":"2015","journal-title":"Stat. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"h3868","DOI":"10.1136\/bmj.h3868","article-title":"How to develop a more accurate risk prediction model when there are few events","volume":"351","author":"Pavlou","year":"2015","journal-title":"BMJ"},{"key":"ref_23","first-page":"574","article-title":"Is biliary pain exclusively related to gallbladder stones? A controlled prospective study","volume":"54","author":"Berger","year":"2004","journal-title":"Br. J. Gen. Pr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1080\/003655200750024560","article-title":"Abdominal symptoms: Do they predict gallstones? A systematic review","volume":"35","author":"Berger","year":"2000","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1016\/j.cgh.2011.05.014","article-title":"Factors That Predict Relief From Upper Abdominal Pain After Cholecystectomy","volume":"9","author":"Thistle","year":"2011","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"E383","DOI":"10.1055\/s-0043-123185","article-title":"The diagnostic yield of open-access endoscopy of the upper gastrointestinal tract in the Netherlands","volume":"06","author":"Crouwel","year":"2018","journal-title":"Endosc. Int. 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