Cost-effective management of common bile duct stones

Urbach, David R.; Khajanchee, Yashodhan S.; Jobe, Blair A.; Standage, Blayne A.; Hansen, Paul; Swanström, Lee L.

doi:10.1007/s004640000322

Cited by 136 publications

(41 citation statements)

References 43 publications

(26 reference statements)

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“…However, it carries a considerable risk of short-term complications such as post-ERCP pancreatitis, post-endoscopic sphincterotomy bleeding, cholangitis and perforation (6). It has been previously stated that the cost-effectiveness is favorable only when performing ERCP in patients with a high likelihood of CL (7). In order to predict the likelihood of a persistent CBD stone in patients with suspected CL, the American Society for Gastrointestinal Endoscopy (ASGE) published guidelines in 2010 for the prediction of CL with the objective of identifying patients with the highest probability of benefiting from ERCP (8).…”

Section: Introductionmentioning

confidence: 99%

Accuracy of ASGE criteria for the prediction of choledocholithiasis

Rivera¹,

Gonzalez²,

Monreal-Robles³

et al. 2016

Rev Esp Enferm Dig

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Background/aims: Few studies have validated the performance of guidelines for the prediction of choledocholithiasis (CL). Our objective was to prospectively assess the accuracy of the American Society for Gastrointestinal Endoscopy (ASGE) guidelines for the identification of CL.Methods: A two-year prospective evaluation of patients with suspected CL was performed. We evaluated the ASGE guidelines and its component variables in predicting CL.Results: A total of 256 patients with suspected CL were analyzed. Of the 208 patients with high-probability criteria for CL, 124 (59.6%) were found to have a stone/sludge at endoscopic retrograde cholangiopancreatography (ERCP). Among 48 patients with intermediate-probability criteria, 21 (43.8%) had a stone/ sludge. The performance of ASGE high-and intermediate-probability criteria in our population had an accuracy of 59.0% (85.5% sensitivity, 24.3% specificity) and 41.0% (14.4% sensitivity, 75.6% specificity), respectively. The mean ERCP delay time was 6.1 days in the CL group and 6.4 days in the group without CL, p = 0.638. The presence of a common bile duct (CBD) > 6 mm (OR 2.21; 95% CI, 1.20-4.10), ascending cholangitis (OR 2.37; 95% CI, 1.01-5.55) and a CBD stone visualized on transabdominal US (OR 3.33; 95% CI, 1.48-7.52) were stronger predictors of CL. The occurrence of biliary pancreatitis was a strong protective factor for the presence of a retained CBD stone (OR 0.30; 95% CI,.Conclusions: Irrespective of a patient's ASGE probability for CL, the application of current guidelines in our population led to unnecessary performance of ERCPs in nearly half of cases.

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Section: Introductionmentioning

confidence: 99%

Accuracy of ASGE criteria for the prediction of choledocholithiasis

Rivera¹,

Gonzalez²,

Monreal-Robles³

et al. 2016

Rev Esp Enferm Dig

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“…Also, if ERCP is now predominately a therapeutic modality, the reasons for this change have not been determined, although changes in cholecystectomy rate and technique and increasing rates of choledocholithiasis and pancreatic cancer have been postulated as causes 10,11,12,13 . Finally, recent US data suggest that rural patients may have a more difficult time accessing ERCP when compared to urban patients, but no population-based data exists to support this claim 12 .…”

Section: Introductionmentioning

confidence: 99%

Trends in utilization of diagnostic and therapeutic ERCP and cholecystectomy over the past 25 years: a population-based study

Moffatt¹,

Yu²,

Yie³

et al. 2014

Gastrointestinal Endoscopy

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“…In addition, LCBDE has the advantage of been a single-stage procedure and seems to be more cost effective [15][16][17]. The procedure, however, is time consuming and requires specific equipment and an increased level of laparoscopic surgical skill.…”

Section: Discussionmentioning

confidence: 98%