Evaluating the Revised American Society for Gastrointestinal Endoscopy Guidelines for Common Bile Duct Stone Diagnosis
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Background/Aims: The American Society for Gastrointestinal Endoscopy (ASGE) revised its guidelines for risk stratification ofpatients with suspected choledocholithiasis. This study aimed to assess the diagnostic performance of the revision and to compare itto the previous guidelines. Methods: We conducted a retrospective cohort study of 267 patients with suspected choledocholithiasis. We identified high-riskpatients according to the original and revised guidelines and examined the diagnostic accuracy of both guidelines. We measured theassociation between individual criteria and choledocholithiasis. Results: Under the original guidelines, 165 (62%) patients met the criteria for high risk, of whom 79% had confirmedcholedocholithiasis. The categorization had a sensitivity and specificity of 68% and 55%, respectively, for the detectionof choledocholithiasis. Under the revised guidelines, 86 (32%) patients met the criteria for high risk, of whom 83% hadcholedocholithiasis. The revised categorization had a lower sensitivity and higher specificity of 37% and 80%, respectively. Thepositive predictive value of the high-risk categorization increased with the revision, reflecting a potential decrease in diagnosticendoscopic retrograde cholangiopancreatograpies (ERCPs). Stone visualized on imaging had the greatest specificity forcholedocholithiasis. 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 animproved risk stratification tool.
Abstract
Background/Aims: The American Society for Gastrointestinal Endoscopy (ASGE) revised its guidelines for risk stratification ofpatients with suspected choledocholithiasis. This study aimed to assess the diagnostic performance of the revision and to compare itto the previous guidelines. Methods: We conducted a retrospective cohort study of 267 patients with suspected choledocholithiasis. We identified high-riskpatients according to the original and revised guidelines and examined the diagnostic accuracy of both guidelines. We measured theassociation between individual criteria and choledocholithiasis. Results: Under the original guidelines, 165 (62%) patients met the criteria for high risk, of whom 79% had confirmedcholedocholithiasis. The categorization had a sensitivity and specificity of 68% and 55%, respectively, for the detectionof choledocholithiasis. Under the revised guidelines, 86 (32%) patients met the criteria for high risk, of whom 83% hadcholedocholithiasis. The revised categorization had a lower sensitivity and higher specificity of 37% and 80%, respectively. Thepositive predictive value of the high-risk categorization increased with the revision, reflecting a potential decrease in diagnosticendoscopic retrograde cholangiopancreatograpies (ERCPs). Stone visualized on imaging had the greatest specificity forcholedocholithiasis. 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 animproved risk stratification tool.
참고문헌 (21)
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