Clinical utility of ESGE and ASGE guidelines for prediction of suspected choledocholithiasis in patients undergoing cholecystectomy

Background Recent guidelines from the European Society of Gastrointestinal Endoscopy (ESGE) and American Society for Gastrointestinal Endoscopy (ASGE) recommend risk stratification according to liver function test (LFT) and abdominal ultrasound in patients with suspected choledocholithiasis. We evaluated and validated the clinical utility of these new risk stratification criteria for choledocholithiasis. Methods We retrospectively analyzed prospectively maintained data of patients with suspected choledocholithiasis between January 2016 and December 2018 in patients undergoing cholecystectomy. Patients with common bile duct stricture, cirrhosis, and portal biliopathy were excluded. After LFT and ultrasound, all patients were stratified according to ESGE and ASGE criteria into high, intermediate, and low likelihood of choledocholithiasis. Results 1042 patients were analyzed. Using ESGE guidelines, 213 patients (20.4%) met high likelihood criteria, 637 (61.1%) met intermediate, and 192 (18.4%) met low likelihood criteria. Using ASGE guidelines, 230 (22.1%), 678 (65.1%), and 134 (12.9%) met high, intermediate, and low likelihood criteria, respectively. Specificity and positive predictive value (PPV) of ASGE high likelihood criteria were 96.87% (95% confidence interval [CI] 95.37 - 97.98) and 89.57% (95 %CI 85.20 - 92.75) for choledocholithiasis compared with 98.96% (95 %CI 97.95 - 99.55) and 96.24% (95% CI 92.76 - 98.09), respectively, for ESGE criteria. ASGE classified 17 (7.4%) additional patients as high likelihood compared with ESGE, only one of whom had choledocholithiasis. ASGE classified 58 (8.6 %) additional patients as intermediate, none of whom had choledocholithiasis. Conclusion This study validates the clinical utility of new ESGE and ASGE criteria for predicting choledocholithiasis. ESGE risk stratification appears more specific than ASGE.