Management of suspected common bile duct stone: diagnostic yield of current guidelines

Kuzu, Ufuk Barış; Ödemiş, Bülent; Dışıbeyaz, Selçuk; Parlak, Erkan; Öztaş, Erkin; Saygılı, Fatih; Yıldız, Hakan; Kaplan, Mustafa; Çoşkun, Orhan; Aksoy, Adem; Arı, Derya; Suna, Nuretdin; Kayaçeti̇n, Ertuğrul

doi:10.1016/j.hpb.2016.11.003

Cited by 24 publications

(25 citation statements)

References 30 publications

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“…Since 2010, multiple institutions have assessed the diagnostic accuracy and clinical utility of the original ASGE risk stratification tool. [6][7][8][9] In all of these studies, between 10% and 50% of the patients in the intermediate-risk group and > 50% of those in the high-risk group had confirmed choledocholithiasis, as intended. In studies including patients with clinical evidence of cholangitis, the high-risk classification had sensitivities ranging from 68% to 80% and specificities ranging from 44% to 74%.…”

Section: Discussionmentioning

confidence: 94%

“…In studies including patients with clinical evidence of cholangitis, the high-risk classification had sensitivities ranging from 68% to 80% and specificities ranging from 44% to 74%. 6,7,9 In a study excluding patients with cholangitis, the sensitivity and specificity was 47% and 73%, respectively, for the high-risk classification. 8 We recommend excluding patients with signs of cholangitis when evaluating the diagnostic accuracy of the tool, as these patients require urgent biliary decompression irrespective of the presence of choledocholithiasis.…”

Section: Discussionmentioning

confidence: 98%

“…To standardize the diagnosis and management of choledocholithiasis, the American Society for Gastrointestinal Endoscopy (ASGE) released a risk stratification tool in 2010 that categorized patients into low, intermediate, and high risk for choledocholithiasis, and offered management suggestions for each category. 6 Several institutions have validated the risk stratification tool since 2010. [7][8][9][10] While the tool achieved its intended aim, it was found to inappropriately triage patients to…”

Section: Introductionmentioning

confidence: 99%

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Evaluating the Revised American Society for Gastrointestinal Endoscopy Guidelines for Common Bile Duct Stone Diagnosis

et al. 2021

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Background/Aims: The American Society for Gastrointestinal Endoscopy (ASGE) revised its guidelines for risk stratification of patients with suspected choledocholithiasis. This study aimed to assess the diagnostic performance of the revision and to compare it to the previous guidelines. Methods: We conducted a retrospective cohort study of 267 patients with suspected choledocholithiasis. We identified high-risk patients according to the original and revised guidelines and examined the diagnostic accuracy of both guidelines. We measured the association between individual criteria and choledocholithiasis. Results: Under the original guidelines, 165 (62%) patients met the criteria for high risk, of whom 79% had confirmed choledocholithiasis. The categorization had a sensitivity and specificity of 68% and 55%, respectively, for the detection of choledocholithiasis. Under the revised guidelines, 86 (32%) patients met the criteria for high risk, of whom 83% had choledocholithiasis. The revised categorization had a lower sensitivity and higher specificity of 37% and 80%, respectively. The positive predictive value of the high-risk categorization increased with the revision, reflecting a potential decrease in diagnostic endoscopic retrograde cholangiopancreatograpies (ERCPs). Stone visualized on imaging had the greatest specificity for choledocholithiasis. Gallstone pancreatitis was not associated with the risk for choledocholithiasis. Conclusions: The 2019 revision of the ASGE guidelines decreases the utilization of ERCP as a diagnostic modality and offers an improved risk stratification tool. Clin Endosc 2020 Nov 6. [Epub ahead of print]

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Evaluating the Revised American Society for Gastrointestinal Endoscopy Guidelines for Common Bile Duct Stone Diagnosis

et al. 2021

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“…The correlation between laboratory, ultrasound, and clinical standards has a 96-98% sensitivity for diagnosis. Lacking these criteria takes less than a 2% chance of choledocholithiasis (Kuzu et al, 2017;Tozatti et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Predicting the Diagnosis of Choledocholithiasis in Elderly Patients by Assessing Hepatic Functions

Tamim¹,

Klimov²

2021

J Biochem Technol

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Choledocholithiasis occurs most ordinarily, the eventuality of common biliary duct stones increases significantly with the age of patients. Our study aimed to is to preoperatively investigate the levels of liver function indexes and results of diagnostic imaging, and their role in the early diagnosis of choledocholithiasis in elderly patients. This study included patients referred to the surgical department of the V. V. Vinogradov state medical center in Moscow, for the periods between 2018 -2020. In this study, 127 patients were divided into two groups: the control group (104 patients), cases group (23 patients), and patients without choledocholithiasis intraoperatively, included the patients with choledocholithiasis intraoperatively. Laboratory markers were studied. The sample was congenerous for age and gender. Our results upon admission to hospital show in cases group biliary pancreatitis in 13%, obstructive jaundice in 30.4% and 91.3% abdominal pain in the right hypochondrium, obstructive jaundice was the clinical symptom with statistical significance (p < 0.05). Patients with choledocholithiasis had higher values of the gammaglutamyl transferase, alkaline phosphatase, glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, and bilirubin (p < 0.01). The diagnostic imaging for the diagnosis of choledocholithiasis showed that ultrasound imaging had elevated specificity. By studying the changes that occur in the liver enzymes, parallel to results of imaging diagnosis, confirming the diagnosis preoperative choledocholithiasis can be predicted. Gamma-glutamyltransferase showed elevated sensitivity, while alkaline phosphatase showed elevated specificity, ultrasound imaging showed elevated specificity.

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“…The primary CBDS is associated with biliary stasis (bile duct stricture, papillary stenosis) and infection in bile duct, whereas secondary CBDS appear due to the migration of a stone from the gallbladder. With higher prevalence among women at the ratio of 2:1, the prevalence rate of gallstone disease is 5-25% and in 20% of the gallstone cases in choledocholithiasis appear simultaneously [1][2][3][4][5]. Clinical manifestation of ChL is similar to acute and chronic cholelithiasis exacerbated with mechanical jaundice [4,5].…”

Section: Introductionmentioning

confidence: 99%

The Role of Transabdominal Sonography in the Diagnostics of Choledocholithiasis: Compared to Endoscopic Retrograde Cholangiopancreatography

Kr¹

2018

CTGH

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Management of suspected common bile duct stone: diagnostic yield of current guidelines

Abstract: The probability of CBDS was observed to be high in the intermediate and high risk groups. However due to low sensitivity and specificity values, the ASGE guideline needs additional or different predictors.

Cited by 24 publications

References 30 publications

Evaluating the Revised American Society for Gastrointestinal Endoscopy Guidelines for Common Bile Duct Stone Diagnosis

Evaluating the Revised American Society for Gastrointestinal Endoscopy Guidelines for Common Bile Duct Stone Diagnosis

Predicting the Diagnosis of Choledocholithiasis in Elderly Patients by Assessing Hepatic Functions

The Role of Transabdominal Sonography in the Diagnostics of Choledocholithiasis: Compared to Endoscopic Retrograde Cholangiopancreatography

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