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Endoscopy 2020; 52(07): 569-573
DOI: 10.1055/a-1117-3451
Original article

Clinical utility of ESGE and ASGE guidelines for prediction of suspected choledocholithiasis in patients undergoing cholecystectomy

Nitin Jagtap
1   Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
,
Yashavanth HS
1   Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
,
Manu Tandan
1   Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
,
Jahangeer Basha
1   Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
,
Radhika Chavan
1   Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
,
Zaheer Nabi
1   Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
,
Rakesh Kalapala
1   Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
,
P. Manohar Reddy
1   Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
,
Mohan Ramchandani
1   Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
,
Rajesh Gupta
1   Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
,
Sundeep Lakhtakia
1   Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
,
Santosh Darishetty
2   Department of Anaesthesiology, Asian Institute of Gastroenterology, Hyderabad; India
,
G. Venkat Rao
3   Department of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
,
D. Nageshwar Reddy
1   Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
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Referred to by:

Diagnosing choledocholithiasis: better to be European or American?Endoscopy 2020; 52(07): 531-532
DOI: 10.1055/a-1170-4847

Referred to by:

Author commentary on Nitin Jagtap et al.Endoscopy 2020; 52(07): v25-v25
DOI: 10.1055/a-1129-1060

Abstract

Background Recent guidelines from the European Society of Gastrointestinal Endoscopy (ESGE) and American Society for Gastrointestinal Endoscopy (ASGE) recommend risk stratification according to liver function test (LFT) and abdominal ultrasound in patients with suspected choledocholithiasis. We evaluated and validated the clinical utility of these new risk stratification criteria for choledocholithiasis.

Methods We retrospectively analyzed prospectively maintained data of patients with suspected choledocholithiasis between January 2016 and December 2018 in patients undergoing cholecystectomy. Patients with common bile duct stricture, cirrhosis, and portal biliopathy were excluded. After LFT and ultrasound, all patients were stratified according to ESGE and ASGE criteria into high, intermediate, and low likelihood of choledocholithiasis.

Results 1042 patients were analyzed. Using ESGE guidelines, 213 patients (20.4 %) met high likelihood criteria, 637 (61.1 %) met intermediate, and 192 (18.4 %) met low likelihood criteria. Using ASGE guidelines, 230 (22.1 %), 678 (65.1 %), and 134 (12.9 %) met high, intermediate, and low likelihood criteria, respectively. Specificity and positive predictive value (PPV) of ASGE high likelihood criteria were 96.87 % (95 % confidence interval [CI] 95.37 – 97.98) and 89.57 % (95 %CI 85.20 – 92.75) for choledocholithiasis compared with 98.96 % (95 %CI 97.95 – 99.55) and 96.24 % (95 %CI 92.76 – 98.09), respectively, for ESGE criteria. ASGE classified 17 (7.4 %) additional patients as high likelihood compared with ESGE, only one of whom had choledocholithiasis. ASGE classified 58 (8.6 %) additional patients as intermediate, none of whom had choledocholithiasis.

Conclusion This study validates the clinical utility of new ESGE and ASGE criteria for predicting choledocholithiasis. ESGE risk stratification appears more specific than ASGE.



Publication History

Received: 03 October 2019

Accepted: 29 January 2020

Article published online:
27 February 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

  • References

  • 1 Manes G, Paspatis G, Aabakken L. et al. Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2019; 51: 472-491
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Halldestam I, Enell EL, Kullman E. et al. Development of symptoms and complications in individuals with asymptomatic gallstones. Br J Surg 2004; 91: 734-738
    CrossrefPubMedGoogle Scholar
  • 3 Shabanzadeh DM, Sorensen LT, Jorgensen T. A prediction rule for risk stratification of incidentally discovered gallstones: results from a large cohort study. Gastroenterology 2016; 150: 156-167
    CrossrefPubMedGoogle Scholar
  • 4 Buxbaum JL, Abbas Fehmi SM. ASGE Standards of Practice Committee. et al. ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis. Gastrointest Endosc 2019; 89: 1075-1105
    CrossrefPubMedGoogle Scholar
  • 5 Talukdar R. Complications of ERCP. Best Pract Res Clin Gastroenterol 2016; 30: 793-805
    CrossrefPubMedGoogle Scholar
  • 6 Adams MA, Hosmer AE, Wamsteker EJ. et al. Predicting the likelihood of a persistent bile duct stone in patients with suspected choledocholithiasis: accuracy of existing guidelines and the impact of laboratory trends. Gastrointest Endosc 2015; 82: 88-93
    CrossrefPubMedGoogle Scholar
  • 7 Maple JT, Ben-Menachem T. ASGE Standards of Practice Committee. et al. The role of endoscopy in the evaluation of suspected choledocholithiasis. Gastrointest Endosc 2010; 71: 1-9
    CrossrefPubMedGoogle Scholar
  • 8 Verma D, Kapadia A, Eisen GM. et al. EUS vs MRCP for detection of choledocholithiasis. Gastrointest Endosc 2006; 64: 248-254
    CrossrefPubMedGoogle Scholar
  • 9 Meeralam Y, Al-Shammari K, Yaghoobi M. Diagnostic accuracy of EUS compared with MRCP in detecting choledocholithiasis: a meta-analysis of diagnostic test accuracy in head-to-head studies. Gastrointest Endosc 2017; 86: 986-993
    CrossrefPubMedGoogle Scholar
  • 10 Chen YI, Martel M, Barkun AN. Choledocholithiasis: Should EUS replace MRCP in patients at intermediate risk?. Gastrointest Endosc 2017; 86: 994-996
    CrossrefPubMedGoogle Scholar
  • 11 Rubin MI, Thosani NC, Tanikella R. et al. Endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis: testing the current guidelines. Dig Liver Dis 2013; 45: 744-749
    CrossrefPubMedGoogle Scholar
  • 12 Suarez AL, LaBarre NT, Cotton PB. et al. An assessment of existing risk stratification guidelines for the evaluation of patients with suspected choledocholithiasis. Surg Endosc 2016; 30: 4613-4618
    CrossrefPubMedGoogle Scholar
  • 13 He H, Tan C, Wu J. et al. Accuracy of ASGE high-risk criteria in evaluation of patients with suspected common bile duct stones. Gastrointest Endosc 2017; 86: 525-532
    CrossrefPubMedGoogle Scholar
  • 14 Magalhaes J, Rosa B, Cotter J. Endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis: from guidelines to clinical practice. World J Gastrointest Endosc 2015; 7: 128-134
    PubMedGoogle Scholar
  • 15 Qiu Y, Yang Z, Li Z. et al. Is preoperative MRCP necessary for patients with gallstones? An analysis of the factors related to missed diagnosis of choledocholithiasis by preoperative ultrasound. BMC Gastroenterol 2015; 15: 158
    CrossrefPubMedGoogle Scholar
  • 16 Wilcox CM, Kim H, Trevino J. et al. Prevalence of normal liver tests in patients with choledocholithiasis undergoing endoscopic retrograde cholangiopancreatography. Digestion 2014; 89: 232-238
    CrossrefPubMedGoogle Scholar