Evaluating the Revised American Society for Gastrointestinal Endoscopy Guidelines for Common Bile Duct Stone Diagnosis

Abstract

Background/Aims: The American Society for Gastrointestinal Endoscopy (ASGE) revised its guidelines for risk stratification of patients with suspected choledocholithiasis. This study aimed to assess the diagnostic performance of the revision and to compare it to the previous guidelines. Methods: We conducted a retrospective cohort study of 267 patients with suspected choledocholithiasis. We identified high-risk patients according to the original and revised guidelines and examined the diagnostic accuracy of both guidelines. We measured the association between individual criteria and choledocholithiasis. Results: Under the original guidelines, 165 (62%) patients met the criteria for high risk, of whom 79% had confirmed choledocholithiasis. The categorization had a sensitivity and specificity of 68% and 55%, respectively, for the detection of choledocholithiasis. Under the revised guidelines, 86 (32%) patients met the criteria for high risk, of whom 83% had choledocholithiasis. The revised categorization had a lower sensitivity and higher specificity of 37% and 80%, respectively. The positive predictive value of the high-risk categorization increased with the revision, reflecting a potential decrease in diagnostic endoscopic retrograde cholangiopancreatograpies (ERCPs). Stone visualized on imaging had the greatest specificity for choledocholithiasis. Gallstone pancreatitis was not associated with the risk for choledocholithiasis. Conclusions: The 2019 revision of the ASGE guidelines decreases the utilization of ERCP as a diagnostic modality and offers an improved risk stratification tool. Clin Endosc 2020 Nov 6. [Epub ahead of print]

National adherence to the ASGE-SAGES guidelines for managing suspected choledocholithiasis: An EAST multicenter study

“…These patients were excluded from our study, which may have decreased our sensitivity and predictive value for choledocholithiasis. More importantly, our study collected patient data from 2016 through 2019 and the revised guidelines for managing suspected choledocholithiasis were released by ASGE-SAGES in 2019 8 . We cannot determine if the newer iteration had any impact on our results; however, these updates may have been a confounder in our final year of data collection.…”

“…Very strong predictors included a CBD stone seen on transabdominal US and a bilirubin greater than 4 mg/dL. Although cholangitis is considered a very strong predictor, we previously excluded these patients in our initial study protocol because they should undergo rapid biliary decompression regardless of the presence of choledocholithiasis 8 . Strong predictors included a CBD greater than 6 mm and a bilirubin 1.8 mg/dL to 4 mg/dL.…”

Readmissions due to biliar complications in patients with acude cholecystitis conservatively treated due to concomitant biliar duct obstruction suspicion: a bicentric study of an usual issue

“…En nuestro estudio analizamos un periodo de 90 días tras el primer ingreso para evaluar la tasa de reingresos. Desde la publicación en 2011 sobre los resultados tras cirugía hepática 12 donde se vio que el aumento a 90 días para medir la mortalidad producía un incremento del 50%, la tendencia actual es a medir las complicaciones y reingresos en los primeros 90 días tras el alta hospitalaria. Si bien es cierto que dicho periodo de tiempo puede ser lo adecuado tras una cirugía, en nuestro estudio puede suponer una limitación dado que no se trata de complicaciones postquirúrgicas, si no de una patología no intervenida.…”

Indetermined Biliary Filling Defects: Sequential Approach Using Ultrasound, MRT and Cholangioscopy (Case Report)

“…ERCP is commonly performed to extract stones, to perform biopsies of intraductal lesions, and place stents. Almost 90% of stones in the choledochal duct can be extracted endoscopically [17,18]. In the context of ERCP, stone extraction can be performed by inflatable balloon catheter or with special basket catheter systems [19,20,21].…”