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

Abstract

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.

Development of a Predictive Model for Common Bile Duct Stones in Patients With Clinical Suspicion of Choledocholithiasis: A Cohort Study

“…This study used the same data as a previously published study [ 15 ]. However, both studies have different research questions, theories, unique analyses, and clinical implications.…”

“…Nevertheless, experienced surgeons and more specialized equipment are required for the treatment of CBD stones, particularly in the laparoscopic era [ 8 ]. In this context, guidelines, recommendations, and scoring systems have been constructed [ 5 , 9 - 13 ]; however, such resources generally were not designed exclusively for patients with suspected CBD stones [ 5 , 9 , 13 ], and they have questionable relevance in high-prevalence populations [ 14 , 15 ]. Notably, published scoring systems are not widely used [ 10 - 12 ].…”

Surgical strategies for challenging common bile duct stones in the endoscopic era: A comprehensive review of current evidence

“…Synchronous common bile duct stone (CBDS) or choledocholithiasis affects approximately 10%-20% of patients with gallstone (GS), a condition known as cholecystolithiasis or cholelithiasis[ 1 , 2 ]. This prevalence is attributed to advanced diagnostic modalities such as endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography[ 2 , 3 ]. CBDS can lead to various serious sequelae, including obstructive jaundice, ascending cholangitis, hepatic abscess, or GS pancreatitis.…”