Comparing diagnostic accuracy of current practice guidelines in predicting choledocholithiasis: outcomes from a large healthcare system comprising both academic and community settings

被引:16
作者
Chandran, Aswathi [1 ]
Rashtak, Shahrooz [1 ]
Patil, Prithvi [1 ]
Gottlieb, Assaf [2 ]
Bernstam, Elmer [2 ]
Guha, Sushovan [1 ]
Ramireddy, Srinivas [1 ]
Badillo, Ricardo [1 ]
DaVee, Roy Tomas [1 ]
Kao, Lillian S. [3 ]
Thosani, Nirav [1 ]
机构
[1] UTHlth, Ctr Intervent Gastroenterol, McGovern Med Sch, UTHlth iGUT, 6431 Fannin St, Houston, TX 77030 USA
[2] UTHlth, Sch Biomed Informat, Houston, TX 77030 USA
[3] UTHlth, UTHlth iGUT, Ctr Intervent Gastroenterol, Houston, TX 77030 USA
关键词
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY; SUSPECTED CHOLEDOCHOLITHIASIS; TEST-PERFORMANCE; METAANALYSIS; CHOLANGIOGRAPHY; EUS;
D O I
10.1016/j.gie.2020.10.033
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background and Aims: The American Society for Gastrointestinal Endoscopy (ASGE) 2010 guidelines for suspected choledocholithiasis were recently updated by proposing more specific criteria for selection of high-risk patients to undergo direct ERCP while advocating the use of additional imaging studies for intermediate- and low-risk individuals. We aim to compare the performance and diagnostic accuracy of 2019 versus 2010 ASGE criteria for suspected choledocholithiasis. Methods: We performed a retrospective chart review of a prospectively maintained database (2013-2019) of over 10,000 ERCPs performed by 70 gastroenterologists in our 14-hospital system. We randomly selected 744 ERCPs in which the primary indication was suspected choledocholithiasis. Patients with a history of cholecystectomy or prior sphincterotomy were excluded. The same patient cohort was assigned as low, intermediate, or high risk according to the 2010 and 2019 guideline criteria. Overall accuracy of both guidelines was compared against the presence of stones and/or sludge on ERCP. Results: Of 744 patients who underwent ERCP, 544 patients (73.1%) had definite stones during ERCP and 696 patients (93.5%) had stones and/or sludge during ERCP. When classified according to the 2019 guidelines, fewer patients were high risk (274/744, 36.8%) compared with 2010 guidelines (449/744, 60.4%; P <.001). Within the high-risk group per both guidelines, definitive stone was found during ERCP more frequently in the 2019 guideline cohort (226/274, 82.5%) compared with the 2010 guideline cohort (342/449, 76.2%; P <.001). In our patient cohort, overall specificity of the 2010 guideline was 46.5%, which improved to 76.0% as per 2019 guideline criteria (P <.001). However, no significant change was noted for either positive predictive value or negative predictive value between 2019 and 2010 guidelines. Conclusions: The 2019 ASGE guidelines are more specific for detection of choledocholithiasis during ERCP when compared with the 2010 guidelines. However, a large number of patients are categorized as intermediate risk per 2019 guidelines and will require an additional confirmatory imaging study.
引用
收藏
页码:1351 / 1359
页数:9
相关论文
共 22 条
[1]   Predicting the likelihood of a persistent bile duct stone in patients with suspected choledocholithiasis: accuracy of existing guidelines and the impact of laboratory trends [J].
Adams, Megan A. ;
Hosmer, Amy E. ;
Wamsteker, Erik J. ;
Anderson, Michelle A. ;
Elta, Grace H. ;
Kubiliun, Nisa M. ;
Kwon, Richard S. ;
Piraka, Cyrus R. ;
Scheiman, James M. ;
Waljee, Akbar K. ;
Hussain, Hero K. ;
Elmunzer, B. Joseph .
GASTROINTESTINAL ENDOSCOPY, 2015, 82 (01) :88-93
[2]  
Arnett DK, 2019, CIRCULATION, V140, pE596, DOI [10.1161/CIR.0000000000000677, 10.1161/CIR.0000000000000678, 10.1016/j.jacc.2019.03.009, 10.1016/j.jacc.2019.03.010]
[3]  
Baron TH, 2012, ERCP, P2
[4]   Randomized Trial of Endoscopist-Controlled vs. Assistant-Controlled Wire-Guided Cannulation of the Bile Duct [J].
Buxbaum, James ;
Leonor, Paul ;
Tung, Jonathan ;
Lane, Christianne ;
Sahakian, Ara ;
Laine, Loren .
AMERICAN JOURNAL OF GASTROENTEROLOGY, 2016, 111 (12) :1841-1847
[5]   Endoscopic ultrasonography versus cholangiography for the diagnosis of choledocholithiasis [J].
Canto, MIF ;
Chak, A ;
Stellato, T ;
Sivak, MV .
GASTROINTESTINAL ENDOSCOPY, 1998, 47 (06) :439-448
[6]   A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy - Natural history of choledocholithiasis revisited [J].
Collins, C ;
Maguire, D ;
Ireland, A ;
Fitzgerald, E ;
O'Sullivan, GC .
ANNALS OF SURGERY, 2004, 239 (01) :28-33
[7]   Sex and ethnic/racial-specific risk factors for gallbladder disease [J].
Figueiredo, Jane C. ;
Haiman, Christopher ;
Porcel, Jacqueline ;
Buxbaum, James ;
Stram, Daniel ;
Tambe, Neal ;
Cozen, Wendy ;
Wilkens, Lynne ;
Le Marchand, Loic ;
Setiawan, Veronica Wendy .
BMC GASTROENTEROLOGY, 2017, 17
[8]   Complications of endoscopic biliary sphincterotomy [J].
Freeman, ML ;
Nelson, DB ;
Sherman, S ;
Haber, GB ;
Herman, ME ;
Dorsher, PJ ;
Moore, JP ;
Fennerty, MB ;
Ryan, ME ;
Shaw, MJ ;
Lande, JD ;
Pheley, AM .
NEW ENGLAND JOURNAL OF MEDICINE, 1996, 335 (13) :909-918
[9]   Detection and management of bile duct stones [J].
Frossard, Jean Louis ;
Morel, Philippe M. .
GASTROINTESTINAL ENDOSCOPY, 2010, 72 (04) :808-816
[10]   Limitations of fluoroscopic intraoperative cholangiography in cases suggestive of choledocholithiasis [J].
Griniatsos, J ;
Karvounis, E ;
Isla, AM .
JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES, 2005, 15 (03) :312-317