Accuracy of 2019 ASGE Guideline and Predictive Parameters for Choledocholithiasis before Endoscopic Retrograde Cholangiopancreatography
Ekkapak Sriussadaporn¹, Assanee Tongyoo¹, Siwanat Pipatbouwornkul¹, Palin Limpavitayaporn¹, Chatchai Mingmalairak¹
Affiliation : ¹ Department of Surgery, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
Background: In 2019, the American Society for Gastrointestinal Endoscopy (ASGE) revised their guidelines for endoscopic management of common bile duct stones (CBDS).
Objective: To evaluate the accuracy of the 2019 ASGE criteria in evaluation of CBDS and to identify additional predictive parameters that might improve the accuracy of those criteria.
Material and Methods: The present study design was a retrospective cohort study. Patients suspected of having CBDS and treated with ERCP by the Surgery Department of Thammasat University Hospital between January 2017 and January 2020 were enrolled. Clinical, laboratory, radiological, and endoscopic data were retrospectively collected by medical chart review.
Results: Five hundred sixty-five patients were enrolled, with 85.8% in the high-risk group by ASGE criteria. CBDS were found in 75.4% by ERCP. The overall high-risk criteria had sensitivity of 90.6%, and accuracy 75.4%. CBDS on imaging was the most powerful criterion with an odds ratio of 3.36 (p<0.01) with the highest sensitivity at 68.1%, specificity at 61.2%, and accuracy at 66.4%. Post-cholecystectomy, age, and elevated alkaline phosphatase (ALP) level were significant factors in finding of CBDS by multivariate analysis. The newly proposed high-risk condition of “TB 1.8 to 4.0 mg/dL, elevated ALP, and CBD dilatation” had improved sensitivity at 92.3%, accuracy at 76.4%, and odds ratio at 4.65 compared to the original high-risk criteria with an odds ratio of 3.90.
Conclusion: The high-risk criteria of the ASGE 2019 guideline is an effective evaluation for patients clinically suspected of having CBDS. Adding a new criterion of “TB 1.8 to 4.0 mg/dL and elevated ALP and CBD dilatation” could make the high-risk criteria more sensitive to CBDS and improve accuracy.
Received 27 June 2022 | Revised 4 August 2022 | Accepted 16 August 2022
DOI: 10.35755/jmedassocthai.2022.10.13685
Keywords : Choledocholithiasis; Common bile duct stone; ASGE guideline; Endoscopic retrograde Cholangiopancreatography; ERCP
