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

Published on Nov 5, 2020in Gastrointestinal Endoscopy6.89
· DOI :10.1016/J.GIE.2020.10.033
Aswathi Chandran1
Estimated H-index: 1
(University of Texas Health Science Center at Houston),
Shahrooz Rashtak1
Estimated H-index: 1
(University of Texas Health Science Center at Houston)
+ 8 AuthorsNirav Thosani23
Estimated H-index: 23
(University of Texas Health Science Center at Houston)
Sources
Abstract
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  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.
References22
Newest
#1James Buxbaum (SC: University of Southern California)H-Index: 24
#2Syed M. Abbas Fehmi (UCSD: University of California, San Diego)H-Index: 9
Last. Sachin Wani (CU: University of Colorado Boulder)H-Index: 68
view all 22 authors...
Each year choledocholithiasis results in biliary obstruction, cholangitis, and pancreatitis in a significant number of patients. The primary treatment, ERCP, is minimally invasive but associated with adverse events in 6% to 15%. This American Society for Gastrointestinal Endoscopy (ASGE) Standard of Practice (SOP) Guideline provides evidence-based recommendations for the endoscopic evaluation and treatment of choledocholithiasis. The Grading of Recommendations Assessment, Development and Evaluat...
56 CitationsSource
#1Jane C. Figueiredo (SC: University of Southern California)H-Index: 36
#2Christopher A. Haiman (SC: University of Southern California)H-Index: 113
Last. Veronica Wendy Setiawan (SC: University of Southern California)H-Index: 34
view all 10 authors...
Gallbladder disease (GBD) is a highly prevalent condition; however, little is known about potential differences in risk factors by sex and ethnicity/race. Our aim was to evaluate dietary, reproductive and obesity-related factors and GBD in multiethnic populations. We performed a prospective analysis from the Multiethnic Cohort study who self-identified as non-Hispanic White (n = 32,103), African American (n = 30,209), Japanese (n = 35,987), Native Hawaiian (n = 6942) and Latino (n = 39,168). GBD...
17 CitationsSource
#1Yaser kh. Meeralam (McMaster University)H-Index: 1
#2Khalil Alshammari (McMaster University)H-Index: 3
Last. Mohammad Yaghoobi (McMaster University)H-Index: 22
view all 3 authors...
Background and Aims There is a wide range of reported sensitivity and specificity for EUS and MRCP in the diagnosis of choledocholithiasis, with lack of a proper meta-analysis of diagnostic test accuracy by using head-to-head comparison. Here, we aimed to compare the diagnostic accuracy of EUS and MRCP in detecting choledocholithiasis by using appropriate methodology recommended by the Cochrane Collaboration. Methods A comprehensive electronic literature search up to January 2017 was done by 2 r...
31 CitationsSource
#1Sachin Wani (Anschutz Medical Campus)H-Index: 68
#2Rajesh N. Keswani (NU: Northwestern University)H-Index: 32
Last. Dayna S. Early (WashU: Washington University in St. Louis)H-Index: 57
view all 53 authors...
Background & Aims On the basis of the Next Accreditation System, trainee assessment should occur on a continuous basis with individualized feedback. We aimed to validate endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) learning curves among advanced endoscopy trainees (AETs) by using a large national sample of training programs and to develop a centralized database that allows assessment of performance in relation to peers. Methods ASGE recognized training pr...
38 CitationsSource
#1Huiqin He (SRRSH: Sir Run Run Shaw Hospital)H-Index: 4
#2Chenfei Tan (SRRSH: Sir Run Run Shaw Hospital)H-Index: 1
Last. John J. Kim (LLUMC: Loma Linda University Medical Center)H-Index: 13
view all 9 authors...
Background and Aims ERCP is recommended for patients considered high risk for choledocholithiasis after biochemical testing and abdominal US. Our aim was to determine whether the American Society for Gastrointestinal Endoscopy (ASGE) guidelines accurately select patients for whom the risk of ERCP is justified. Methods Consecutive patients hospitalized with suspected choledocholithiasis at Sir Run Run Shaw Hospital who received biochemical testing, abdominal US, and definitive testing for choledo...
27 CitationsSource
#1Robert J. Huang (Stanford University)H-Index: 12
#2Nirav Thosani (Stanford University)H-Index: 23
Last. Subhas Banerjee (Stanford University)H-Index: 47
view all 8 authors...
Background and Aims Bile duct surgery (BDS), percutaneous transhepatic cholangiography (PTC), and ERCP are alternative interventions used to treat biliary disease. Our aim was to describe trends in ERCP, BDS, and PTC on a nationwide level in the United States. Methods We used the National Inpatient Sample to estimate age-standardized utilization trends of inpatient diagnostic ERCP, therapeutic ERCP, BDS, and PTC between 1998 and 2013. We calculated average case fatality, length of stay, patient ...
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#1James BuxbaumH-Index: 24
#2Paul LeonorH-Index: 2
Last. Loren Laine (Yale University)H-Index: 15
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Randomized Trial of Endoscopist-Controlled vs. Assistant-Controlled Wire-Guided Cannulation of the Bile Duct
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#1Alejandro L. Suarez (MUSC: Medical University of South Carolina)H-Index: 8
#2Nicolas LaBarre (MUSC: Medical University of South Carolina)H-Index: 2
Last. B. Joseph Elmunzer (MUSC: Medical University of South Carolina)H-Index: 31
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Background Prior studies have demonstrated that existing risk stratification guidelines for the evaluation of suspected choledocholithiasis lack accuracy, leading to the overutilization of endoscopic retrograde cholangiopancreatography (ERCP). The aim of our study was to evaluate the performance characteristics of published guidelines in predicting choledocholithiasis and to determine the impact of laboratory trends on diagnostic accuracy.
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#1Megan A. Adams (UM: University of Michigan)H-Index: 11
#2Amy Hosmer (UM: University of Michigan)H-Index: 7
Last. B. Joseph Elmunzer (UM: University of Michigan)H-Index: 31
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Background Existing guidelines aim to stratify the likelihood of choledocholithiasis to guide the use of ERCP versus a lower-risk diagnostic study such as EUS, MRCP, or intraoperative cholangiography. Objective To assess the performance of existing guidelines in predicting choledocholithiasis and to determine whether trends in laboratory parameters improve diagnostic accuracy. Design Retrospective cohort study. Setting Tertiary-care hospital. Patients Hospitalized patients presenting with suspec...
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#1Joana MagalhãesH-Index: 16
#2Bruno RosaH-Index: 18
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AIM: To study the practical applicability of the American Society for Gastrointestinal Endoscopy guidelines in suspected cases of choledocholithiasis. METHODS: This was a retrospective single center study, covering a 4-year period, from January 2010 to December 2013. All patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for suspected choledocholithiasis were included. Based on the presence or absence of predictors of choledocholithiasis (clinical ascending cholangitis,...
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