Prospective assessment of the accuracy of ASGE and ESGE guidelines for choledocholithiasis

Andy Silva-Santisteban; Ishani Shah; Madhuri Chandnani; Vaibhav Wadhwa; Leo Tsai; Abraham F Bezuidenhout; Tyler M Berzin; Douglas Pleskow; Mandeep Sawhney

doi:10.1055/a-2089-0344

Prospective assessment of the accuracy of ASGE and ESGE guidelines for choledocholithiasis

Endosc Int Open. 2023 Jun 21;11(6):E599-E606. doi: 10.1055/a-2089-0344. eCollection 2023 Jun.

Authors

Andy Silva-Santisteban^{1

2}, Ishani Shah^{1

2}, Madhuri Chandnani^{1

2}, Vaibhav Wadhwa^{1

2}, Leo Tsai^{3

4}, Abraham F Bezuidenhout^{3

4}, Tyler M Berzin^{1

2}, Douglas Pleskow^{1

2}, Mandeep Sawhney^{1

2}

Affiliations

¹ Div. of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, United States.
² Department of Medicine, Harvard Medical School, Boston, United States.
³ Department of Radiology, Beth Israel Deaconess Medical Center, Boston, United States.
⁴ Department of Radiology, Harvard Medical School, Boston, United States.

Abstract

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.

The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).