Impact Of Esge Criteria In Evaluation Of Patients With Suspected Common Bile Duct Stones. Real Life Experience In A High-Volume Center

Aims According to ESGE guidelines ERCP should be performed in patients without cholangitis only when common bile duct stones are visible on imaging modalities.

Our aim was to determine the performance characteristics of the ESGE guidelines in selecting patients in whom ERCP is justified and to analyze their impact in a real-life clinical practice setting.

Methods Consecutive patients hospitalized with suspected choledocholithiasis at Gastroenterology Unit ASST Sette-Laghi Varese from April 2019 to April 2020 were included in the study.

Patients with features of cholangitis or choledocholithiasis on abdominal US were considered high risk. Patients with abnormal liver function tests and or common bile duct dilation were considered intermediate risk and ERCP was performed only after positive EUS or MRCP. Patients with normal liver function tests and US were considered low risk.

Results Of 146 patients with suspected choledocholithiasis, 3 (2 %) met low-risk criteria, 114 (78 %) met intermediate risk and 29 (20 %) met High-risk. In patients with low-risk ERCP wasn’t performed and follow-up was negative for choledocholithiasis. Imaging testing (EUS in 2 and MRCP 109) revealed choledocholithiasis in 38 (34 %) patients. ERCP was performed in 37 patients and revealed presence of common bile duct stones in 27 (73 %) of these patients, no other case of choledocholithiasis was found during follow-up. The specificity of the ESGE intermediate-risk criteria was 88 % and positive predictive value was 73 %, 111 imaging test were performed to find out 27 cases of choledocholithiasis. 22 ERCP were performed in patient at high-risk and common bile duct-stones were present in 17.

Conclusions ESGE intermediate risk criteria showed good probability of the patient having choledocholithiasis and reduce risk of performing unnecessary ERCP but more than a half of the patients received imaging test that were negative and this could have an impact on costs and logistic issues.

Citation Balzarini M, Mariotto E, Parravicini M etal. eP319 IMPACT OF ESGE CRITERIA IN EVALUATION OF PATIENTS WITH SUSPECTED COMMON BILE DUCT STONES. REAL LIFE EXPERIENCE IN A HIGH-VOLUME CENTER. Endoscopy 2021; 53: S202.

Publication History

Article published online:
19 March 2021