Year 2016 / Volume 108 / Number 6
Original
Accuracy of ASGE criteria for the prediction of choledocholithiasis

309-314

DOI: 10.17235/reed.2016.4212/2016

Rodrigo Manuel Nárvaez Rivera, José Alberto González González, Roberto Monreal Robles, Diego García Compean, Jonathan Paz Delgadillo, Aldo Azael Garza Galindo, Héctor Jesús Maldonado Garza,

Abstract
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, 0.17-0.55). 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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Nárvaez Rivera R, González González J, Monreal Robles R, García Compean D, Paz Delgadillo J, Garza Galindo A, et all. Accuracy of ASGE criteria for the prediction of choledocholithiasis. 4212/2016


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Publication history

Received: 20/01/2016

Accepted: 04/04/2016

Online First: 11/04/2016

Published: 03/06/2016

Article revision time: 61 days

Article Online First time: 82 days

Article editing time: 135 days


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