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Accuracy of SAGES, ASGE, and ESGE criteria in predicting choledocholithiasis
Kinzang Wangchuk1, Pongsakorn Srichan2
1Department of Surgery, Surin Hospital, Surin, 32000, Thailand. kinchhuk@icloud.com.
Insights
The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), American Society for Gastrointestinal Endoscopy (ASGE), and European Society of Gastrointestinal Endoscopy (ESGE) criteria show acceptable accuracy for diagnosing choledocholithiasis (CDL). Visualized common bile duct stones (CBDS) on imaging indicate the highest risk for CDL.
Area of Science:
- Gastroenterology
- Diagnostic Accuracy
- Clinical Risk Stratification
Background:
- Patients with suspected choledocholithiasis (CDL) are stratified into high-risk (HR), intermediate-risk (IR), and low-risk (LR) groups based on SAGES, ASGE, and ESGE guidelines.
- Validation studies for these risk stratification approaches are limited.
Purpose of the Study:
- To evaluate the diagnostic accuracy of SAGES, ASGE, and ESGE risk stratification criteria in predicting CDL.
- To identify key indicators for high-risk CDL patients.
Main Methods:
- A retrospective cohort study involving 280 patients with suspected CDL.
- Patients were stratified using SAGES, ASGE, and ESGE criteria.
- Diagnostic performance of the criteria was evaluated.
Main Results:
- The HR group showed acceptable diagnostic accuracy, with Area Under the Curve (AUC) values ranging from 0.74 to 0.77 for SAGES, ASGE, and ESGE criteria.
- Diagnostic accuracy in the HR group varied: SAGES (78.93%), ASGE (75%), and ESGE (70%).
- Visualized common bile duct stones (CBDS) on imaging presented the highest risk for CDL (OR, 13.59), followed by CBDS with a dilated common bile duct or cholangitis, and elevated total bilirubin levels.
Conclusions:
- Current SAGES, ASGE, and ESGE criteria demonstrate acceptable diagnostic accuracy for CDL.
- The presence of visualized CBDS on imaging is the strongest predictor of CDL, signifying the highest risk.
Background:
Patients with suspected choledocholithiasis (CDL) are stratified as high-risk (HR), intermediate-risk (IR), and low-risk (LR) according to the guidelines of Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), American Society for Gastrointestinal Endoscopy (ASGE), and European Society of Gastrointestinal Endoscopy (ESGE). Although these approaches are invaluable, paucity of validation studies are currently available. This study aimed to evaluate the diagnostic accuracy of the above risk stratification criteria in predicting CDL.
Methods:
We conducted a retrospective cohort study of 280 patients with suspected CDL. All patients were stratified according to above professional societies as HR, IR, and LR, and diagnostic performance was evaluated.
Results:
In the HR group, area under the receiver operating characteristic curve (AUC) were 0.77 [95% confidence interval (CI), 0.70-0.84], 0.75 (95% CI, 0.68-0.81), and 0.74 (95% CI, 0.68-0.81) for SAGES, ASGE, and ESGE criteria, respectively. The diagnostic accuracy were 78.93% (81.13% sensitivity, 72.06% specificity), 75% (75.47% sensitivity, 73.53% specificity), and 70% (66.04% sensitivity, 82.35% specificity) for SAGES, ASGE, and ESGE criteria, respectively. Regarding the IR group, the diagnostic accuracy were 22.50% (16.98% sensitivity, 39.71% specificity), 25% (24.53% sensitivity, 26.47% specificity), and 30.00% (33.49% sensitivity, 19.12% specificity) for SAGES, ASGE, and ESGE criteria, respectively. The common bile duct stone (CBDS) visualized on imaging has the highest risk for CDL [odds ratio (OR), 13.59 (95% CI, 5.26-35.12)], followed by CBDS plus dilated common bile duct [OR, 13.33 (95% CI, 5.16-34.47)], CBDS plus cholangitis [OR, 13.33 (95% CI, 3.17-56.15)], and CBDS plus total bilirubin level > 1.7 mg/dL [OR, 9.89 (95% CI, 3.47-28.20)].
Conclusions:
The current SAGES, ASGE, and ESGE criteria have acceptable diagnostic accuracy for CDL. The patients with visualized CBDS on imaging have the highest risk for CDL.
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