Prospective assessment of the accuracy of ASGE and ESGE guidelines for choledocholithiasis
Background and study aims American Society of Gastrointestinal Endoscopy (ASGE) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines recommend categorizing patients by risk for choledocholithiasis to determine management. The goal of our study was to compare the accuracy of criteria...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Georg Thieme Verlag KG
2023-06-01
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| Series: | Endoscopy International Open |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/a-2089-0344 |
| _version_ | 1797798159254028288 |
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| author | Andy Silva-Santisteban Ishani Shah Madhuri Chandnani Vaibhav Wadhwa Leo Tsai Abraham F. Bezuidenhout Tyler M. Berzin Douglas Pleskow Mandeep Sawhney |
| author_facet | Andy Silva-Santisteban Ishani Shah Madhuri Chandnani Vaibhav Wadhwa Leo Tsai Abraham F. Bezuidenhout Tyler M. Berzin Douglas Pleskow Mandeep Sawhney |
| author_sort | Andy Silva-Santisteban |
| collection | DOAJ |
| description | Background and study aims American Society of Gastrointestinal Endoscopy (ASGE) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines recommend categorizing patients by risk for choledocholithiasis to determine management. The goal of our study was to compare the accuracy of criteria proposed in these guidelines.
Patients and methods All patients with suspected choledocholithiasis at our institution were prospectively identified. Based upon initial test results, patients were categorized as low, intermediate, and high risk for choledocholithiasis per ASGE 2010 and 2019, and ESGE criteria. Patients were followed until 30 days post-discharge. Results of endoscopic retrograde cholangiography (ERCP), endoscopic ultrasound, and magnetic resonance cholangiopancreatography were used as criteria standard for choledocholithiasis. The accuracy of each criterion for choledocholithiasis was computed.
Results During the study period, 359 consecutive patients with
suspected choledocholithiasis were identified, of whom 225 had choledocholithiasis. Median
patient age was 69 years and 55.3% were women. ESGE criteria categorized 47.9% as high-risk,
lower than ASGE 2010 (62.7%, P<0.01), and 2019 criteria (54.6%,
P=0.07). In high-risk patients, choledocholithiasis was noted in
83.1% for ESGE criteria, similar for ASGE 2019 (81.6%, P=0.7) and
2010 criteria (79.1%, P=0.3). The percentage of patients who
underwent unnecessary ERCP was 8.1% per ESGE criteria, lower than ASGE 2010 (13.1%, P=0.03), but similar to 2019 criteria (10%, P=0.4). No difference in accuracy for choledocholithiasis was noted among the three
criteria. No 30-day readmissions for choledocholithiasis were noted in the low-risk
category.
Conclusions ESGE and ASGE guidelines have similar accuracy for diagnosis of choledocholithiasis. However, ESGE criteria result in more patients needing additional testing, but also a smaller proportion of patients undergoing unnecessary ERCP. |
| first_indexed | 2024-03-13T03:59:19Z |
| format | Article |
| id | doaj.art-baca39667a9a4ff492687b393625b72f |
| institution | Directory Open Access Journal |
| issn | 2364-3722 2196-9736 |
| language | English |
| last_indexed | 2024-03-13T03:59:19Z |
| publishDate | 2023-06-01 |
| publisher | Georg Thieme Verlag KG |
| record_format | Article |
| series | Endoscopy International Open |
| spelling | doaj.art-baca39667a9a4ff492687b393625b72f2023-06-21T22:55:07ZengGeorg Thieme Verlag KGEndoscopy International Open2364-37222196-97362023-06-011106E599E60610.1055/a-2089-0344Prospective assessment of the accuracy of ASGE and ESGE guidelines for choledocholithiasisAndy Silva-Santisteban0Ishani Shah1Madhuri Chandnani2Vaibhav Wadhwa3Leo Tsai4Abraham F. Bezuidenhout5Tyler M. Berzin6Douglas Pleskow7Mandeep Sawhney8Div. of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, United StatesDiv. of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, United StatesDiv. of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, United StatesDiv. of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, United StatesDepartment of Radiology, Beth Israel Deaconess Medical Center, Boston, United StatesDepartment of Radiology, Beth Israel Deaconess Medical Center, Boston, United StatesDiv. of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, United StatesDiv. of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, United StatesDiv. of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, United StatesBackground and study aims American Society of Gastrointestinal Endoscopy (ASGE) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines recommend categorizing patients by risk for choledocholithiasis to determine management. The goal of our study was to compare the accuracy of criteria proposed in these guidelines. Patients and methods All patients with suspected choledocholithiasis at our institution were prospectively identified. Based upon initial test results, patients were categorized as low, intermediate, and high risk for choledocholithiasis per ASGE 2010 and 2019, and ESGE criteria. Patients were followed until 30 days post-discharge. Results of endoscopic retrograde cholangiography (ERCP), endoscopic ultrasound, and magnetic resonance cholangiopancreatography were used as criteria standard for choledocholithiasis. The accuracy of each criterion for choledocholithiasis was computed. Results During the study period, 359 consecutive patients with suspected choledocholithiasis were identified, of whom 225 had choledocholithiasis. Median patient age was 69 years and 55.3% were women. ESGE criteria categorized 47.9% as high-risk, lower than ASGE 2010 (62.7%, P<0.01), and 2019 criteria (54.6%, P=0.07). In high-risk patients, choledocholithiasis was noted in 83.1% for ESGE criteria, similar for ASGE 2019 (81.6%, P=0.7) and 2010 criteria (79.1%, P=0.3). The percentage of patients who underwent unnecessary ERCP was 8.1% per ESGE criteria, lower than ASGE 2010 (13.1%, P=0.03), but similar to 2019 criteria (10%, P=0.4). No difference in accuracy for choledocholithiasis was noted among the three criteria. No 30-day readmissions for choledocholithiasis were noted in the low-risk category. Conclusions ESGE and ASGE guidelines have similar accuracy for diagnosis of choledocholithiasis. However, ESGE criteria result in more patients needing additional testing, but also a smaller proportion of patients undergoing unnecessary ERCP.http://www.thieme-connect.de/DOI/DOI?10.1055/a-2089-0344 |
| spellingShingle | Andy Silva-Santisteban Ishani Shah Madhuri Chandnani Vaibhav Wadhwa Leo Tsai Abraham F. Bezuidenhout Tyler M. Berzin Douglas Pleskow Mandeep Sawhney Prospective assessment of the accuracy of ASGE and ESGE guidelines for choledocholithiasis Endoscopy International Open |
| title | Prospective assessment of the accuracy of ASGE and ESGE guidelines for choledocholithiasis |
| title_full | Prospective assessment of the accuracy of ASGE and ESGE guidelines for choledocholithiasis |
| title_fullStr | Prospective assessment of the accuracy of ASGE and ESGE guidelines for choledocholithiasis |
| title_full_unstemmed | Prospective assessment of the accuracy of ASGE and ESGE guidelines for choledocholithiasis |
| title_short | Prospective assessment of the accuracy of ASGE and ESGE guidelines for choledocholithiasis |
| title_sort | prospective assessment of the accuracy of asge and esge guidelines for choledocholithiasis |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/a-2089-0344 |
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