Accuracy of ASGE high-risk criteria in evaluation of patients with suspected common bile duct stones

He, Haifei; Tan, Chenfei; Jing, Wu; Dai, Ning; Hu, Weiling; Zhang, Yawen; Laine, Loren; Scheiman, James M.; Kim, John J.

doi:10.1016/j.gie.2017.01.039

Cited by 79 publications

(106 citation statements)

References 14 publications

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“…They therefore recommend routinely avoiding the use of the more invasive ERCP, when possible, and instead reserving it for patients already graded as high risk for CBDS[24,28]. …”

Section: Assessing Associated Cbdsmentioning

confidence: 99%

Acute calculous cholecystitis: Review of current best practices

Gomes¹,

Soares²,

Saverio³

et al. 2017

WJGS

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Acute calculous cholecystitis (ACC) is the most frequent complication of cholelithiasis and represents one-third of all surgical emergency hospital admissions, many aspects of the disease are still a matter of debate. Knowledge of the current evidence may allow the surgical team to develop practical bedside decision-making strategies, aiming at a less demanding procedure and lower frequency of complications. In this regard, recommendations on the diagnosis supported by specific criteria and severity scores are being implemented, to prioritize patients eligible for urgency surgery. Laparoscopic cholecystectomy is the best treatment for ACC and the procedure should ideally be performed within 72 h. Early surgery is associated with better results in comparison to delayed surgery. In addition, when to suspect associated common bile duct stones and how to treat them when found are still debated. The antimicrobial agents are indicated for high-risk patients and especially in the presence of gallbladder necrosis. The use of broad-spectrum antibiotics and in some cases with antifungal agents is related to better prognosis. Moreover, an emerging strategy of not converting to open, a difficult laparoscopic cholecystectomy and performing a subtotal cholecystectomy is recommended by adept surgical teams. Some authors support the use of percutaneous cholecystostomy as an alternative emergency treatment for acute Cholecystitis for patients with severe comorbidities.

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“…They therefore recommend routinely avoiding the use of the more invasive ERCP, when possible, and instead reserving it for patients already graded as high risk for CBDS[24,28]. …”

Section: Assessing Associated Cbdsmentioning

confidence: 99%

Acute calculous cholecystitis: Review of current best practices

Gomes¹,

Soares²,

Saverio³

et al. 2017

WJGS

View full text Add to dashboard Cite

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“…Overall, in this study, the accuracy of the guidelines was 63% (sensitivity 54.9% and specificity 68.6%). In China, the largest published series included 1,171 patients with high-risk criteria [5] . Of these 1,171 patients, definitive testing (MRCP, EUS, IOFC, and ERCP) revealed CBD stones in 1,076 (40%) patients (70% sensitivity and 74.3% specificity).…”

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confidence: 99%

“…I remember that patients at high risk were defined as having a probability of choledocholithiasis >50%. Published series reported that patients with high-risk criteria for CBD stones had a documented stone/sludge in a range between 40 and 79.8% (average 60.1%) of the ERCPs [2,3,5,[14][15][16] . The majority of the published series concluded that the ASGE criteria demonstrated a probability of >50% of the patients having CBD stones.…”

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confidence: 99%

“…The majority of the published series concluded that the ASGE criteria demonstrated a probability of >50% of the patients having CBD stones. However, authors should also consider that the ASGE guidelines performed suboptimally, and the application of the current guidelines would lead to unnecessary diagnostic ERCPs in more than one-third of the patients, which is not acceptable [2,3,5,[14][15][16] .…”

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confidence: 99%

“…He et al [5] suggest that a revised algorithm with more stringent criteria that includes choledocholithiasis on abdominal US and/or bilirubin levels >4 mg/dL plus CBD dilation on abdominal US may improve patient selection and reduce the risk of diagnostic ERCP. However, in the clinical scenario, most of the authors [3,5,[14][15][16] , including myself, advocate the use of alternative diagnostic strategies for all patients with high and intermediate probability of choledocholithiasis, namely MRCP or EUS before ERCP. The ASGE guidelines should be used carefully because they are not a fairy tale for sure, and a lifethreatening complication of a diagnostic ERCP is always a nightmare.…”

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confidence: 99%

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Once upon a Time a Guideline Was Used for the Evaluation of Suspected Choledocholithiasis: A Fairy Tale or a Nightmare

Canena¹

2017

GE Port J Gastroenterol

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Evaluation of the American Society of Gastrointestinal Endoscopy 2019 and the European Society of Gastrointestinal Endoscopy guidelines' performances for choledocholithiasis prediction in clinically suspected patients: A retrospective cohort study

et al. 2022

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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.

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Accuracy of ASGE high-risk criteria in evaluation of patients with suspected common bile duct stones

Cited by 79 publications

References 14 publications

Acute calculous cholecystitis: Review of current best practices

Acute calculous cholecystitis: Review of current best practices

Once upon a Time a Guideline Was Used for the Evaluation of Suspected Choledocholithiasis: A Fairy Tale or a Nightmare

Evaluation of the American Society of Gastrointestinal Endoscopy 2019 and the European Society of Gastrointestinal Endoscopy guidelines' performances for choledocholithiasis prediction in clinically suspected patients: A retrospective cohort study

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