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Background and Aim The American Society of Gastrointestinal Endoscopy (ASGE) and the European Society of Gastrointestinal Endoscopy (ESGE) have published guidelines for choledocholithiasis. However, the guidelines were formulated using data from a large number of patients with no to low risk of common bile duct (CBD) stones. This study aimed to assess the guidelines' predictive performance in a population with a high frequency of stones. Methods Data for three choledocholithiasis standard reference tests were retrospectively reviewed from January 2019 to June 2021. Clinical parameters were used to categorize patients into risk groups according to the guidelines, and then the guidelines' predictive abilities were calculated. Results Among 1185 patients, 521 were included. The stone prevalence was 61.0% (n = 318). Twelve (2.3%), 146 (28.0%), and 363 (69.7%) patients were classified into low‐, intermediate‐, and high‐risk groups according to the ASGE guidelines, and 30 (5.8%), 149 (28.6%), and 342 (65.6%) according to the ESGE guidelines. Focusing on the high‐risk group, the ASGE guidelines had a positive predictive value of 73.6 and a positive likelihood ratio of 1.78. The ESGE guidelines had a positive predictive value of 73.7 and positive likelihood ratio of 1.79. Both guidelines had equivalent areas under the receiver operating characteristic curve of 0.69 (95% confidence interval [CI]: 0.65–0.73) and 0.68 (95% CI: 0.64–0.72), respectively. Conclusion In the high‐risk group, the guidelines increased the chance of detecting choledocholithiasis by approximately 10% (61.0% prevalence to 73.6 and 73.7% positive predictive value). However, statistically, the guidelines had marginal discriminative performance in a population with high stone prevalence.

Colonic actinomycosis is rare and can present as an ill-defined intra-abdominal mass that can be difficult to differentiate from colon cancer. This case report aims to share the details of this case and provide diagnostic clues. A 63-year-old female presented with a palpable right-sided abdominal mass. Computed tomography (CT) revealed irregular thickening of the colonic hepatic flexure, and colonoscopy detected no abnormalities. Five months later, the patient returned with an increase in the mass size. Repeat CT revealed lesion expansion, with suspected abdominal wall invasion. Extended right-hemicolectomy with abdominal wall wedge resection was performed, and the histological results were compatible with actinomycosis infection. Colonic actinomycosis is a rare chronic inflammatory disease. Normal colonic mucosa during colonoscopy, with clinical and imaging findings, may help physicians diagnose the condition preoperatively.

BackgroundCurrent choledocholithiasis guidelines heavily focus on patients with low or no risk; they may be inappropriate for populations with high rates of choledocholithiasis. We aimed to develop a predictive scoring model for choledocholithiasis in patients with relevant clinical manifestations. MethodsDesign: A multivariable predictive model development study based on a retrospective cohort of patients with clinical suspicion of choledocholithiasis. Setting: A single 700-bed tertiary public hospital. Participants: Patients who completed three reference tests (endoscopic retrograde cholangiography, magnetic resonance cholangiopancreatography, and intraoperative cholangiography) from January 2019 to June 2021.Statistical analysis: The model was developed using logistic regression analysis. Predictor selection was conducted using a backward stepwise approach. Three risk groups were considered. Model performance was evaluated by area under the receiver-operating characteristic curve, calibration, classification measures, and decision curve analyses. Results Six hundred twenty-one patients were included; the choledocholithiasis prevalence was 59.9%. The predictors were age > 55 years, pancreatitis, cholangitis, cirrhosis, alkaline phosphatase level 125–250 or > 250 U/L, total bilirubin level > 4 mg/dL, common bile duct size > 6 mm, and common bile duct stone detection. Pancreatitis and cirrhosis each had a negative score. The sum of scores was -4.5 to 28.5. Patients were categorized into three risk groups: low-intermediate (score ≤ 5), intermediate (score 5–15), and high (score ≥ 15). Positive likelihood ratios were 0.16 and 3.47 in the low-intermediate and high risk groups, respectively.The model had an area under the receiver-operating characteristic curve of 0.80 (95% confidence interval: 0.76, 0.83) and was well-calibrated; it exhibited better statistical suitability to the high-prevalence population, compared to current guidelines. ConclusionsOur scoring model had good predictive ability for choledocholithiasis in patients with relevant clinical manifestations. Consideration of other factors is necessary for clinical application, particularly regarding the availability of expert physicians and specialized equipment.