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Erschienen in:

15.10.2021

Validation of choledocholithiasis predictors from the “2019 ASGE Guideline for the role of endoscopy in the evaluation and management of choledocholithiasis.”

verfasst von: Stephen Hasak, Scott McHenry, Bradley Busebee, Shahroz Fatima, Ian Sloan, Michael Weaver, Vivek Hansalia, Arvind Rengarajan, Aymen Almuhaidb, Abdullah Al-Shahrani, Thomas Hollander, Dayna Early, Gabriel Lang, Koushik Das, Natalie Cosgrove, Daniel Mullady, Daniel R. Ludwig, Chet Hammill, Vladimir Kushnir

Erschienen in: Surgical Endoscopy | Ausgabe 6/2022

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Abstract

Background and AIMS

Identifying patients likely to have CDL is an important clinical dilemma because endoscopic retrograde cholangiopancreatography (ERCP), carries a 5–7% risk of adverse events. The purpose of this study was to compare the diagnostic test performance of the 2010 and 2019 ASGE criteria used to help risk stratify patients with suspected CDL.

Methods

Consecutive patients evaluated for possible CDL from 2013 to 2019 were identified from surgical, endoscopic, and radiologic databases at a single academic center. Inclusion criteria included all patients who underwent ERCP and/or cholecystectomy with intraoperative cholangiogram (IOC) for suspected CDL. We calculated the diagnostic test performance of criteria from both guidelines and compared their discrimination using the receiver operator curve. Univariate and multivariate analysis was used to identify the strongest component predictors.

Results

1098 patients [age 57.9 ± 19.0 years, 62.8% (690) F] were included. 66.3% (728) were found to have CDL on ERCP and/or IOC. When using the 2019 guidelines, the sensitivity, specificity, PPV, NPV, and accuracy are 65.8, 78.9, 86.3, 54.1, and 70.4%, respectively. Using the 2010 guidelines, the sensitivity, specificity, PPV, NPV, and accuracy are 50.5, 78.9, 82.5, 44.8, and 60.1%, respectively. The AUC for high-risk criteria using the 2019 guidelines [0.726 (0.695, 0.758)] was greater than for the 2010 guidelines [0.647 (0.614, 0.681)]. The key difference providing the increased discrimination was the inclusion of stones on any imaging modality, which increased the sensitivity to 55.0% from 29.1%. Not including CDL on imaging or cholangitis, a dilated CBD was the strongest individual predictor of CDL on multivariate analysis (OR 3.70, CI 2.80, 4.89).

Conclusion

Compared to 2010, the 2019 high-risk criterion improves diagnostic test performance, but still performs suboptimally. Less invasive tests, such as EUS or MRCP, should be considered in patients with suspected CDL prior to ERCP.
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Metadaten
Titel
Validation of choledocholithiasis predictors from the “2019 ASGE Guideline for the role of endoscopy in the evaluation and management of choledocholithiasis.”
verfasst von
Stephen Hasak
Scott McHenry
Bradley Busebee
Shahroz Fatima
Ian Sloan
Michael Weaver
Vivek Hansalia
Arvind Rengarajan
Aymen Almuhaidb
Abdullah Al-Shahrani
Thomas Hollander
Dayna Early
Gabriel Lang
Koushik Das
Natalie Cosgrove
Daniel Mullady
Daniel R. Ludwig
Chet Hammill
Vladimir Kushnir
Publikationsdatum
15.10.2021
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 6/2022
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-021-08752-z

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