Low Detection Rates of Bile Duct Stones During Endoscopic Treatment for Highly Suspected Bile Duct Stones with No...

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Diagnostic Imaging

Background:

• The American Society for Gastrointestinal Endoscopy (ASGE) revised its guideline in 2019, establishing high-risk criteria for suspected common bile duct stones (CBDSs).
• Accurate identification of high-risk patients is crucial for optimizing the use of invasive procedures like ERCP.

Purpose of the Study:

• To evaluate the detection rates of common bile duct stones (CBDSs) during endoscopic retrograde cholangiopancreatography (ERCP).
• To assess these rates in patients identified as high-risk based on the 2019 ASGE guideline criteria for suspected CBDSs.

Main Methods:

• A multicenter retrospective study involving 1100 consecutive patients undergoing ERCP for suspected CBDSs.
• Patients were categorized based on the 2019 ASGE high-risk criteria: CBDSs on imaging, clinical ascending cholangitis, or elevated total bilirubin with a dilated common bile duct.
• Comparison of CBDS detection rates using individual and combined criteria.

Main Results:

• Patients with imaging-confirmed CBDSs (Criterion 1) had a high detection rate of 93.4% when this was the sole criterion met.
• The overall detection rate for patients meeting any high-risk criterion was 86.0%.
• Patients meeting only clinical criteria (cholangitis and/or elevated bilirubin with ductal dilation) showed significantly lower detection rates compared to those with imaging evidence.

Conclusions:

• Visualization of common bile duct stones (CBDSs) on imaging is a strong predictor of detection during ERCP, yielding very high success rates.
• Relying solely on clinical predictors like cholangitis or specific bilirubin/imaging findings without imaging confirmation may lead to a higher proportion of non-diagnostic ERCPs, potentially indicating unnecessary procedures.