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Surgical Endoscopy

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01-10-2016

An assessment of existing risk stratification guidelines for the evaluation of patients with suspected choledocholithiasis

Authors: Alejandro L. Suarez, Nicolas T. LaBarre, Peter B. Cotton, K. Mark Payne, Gregory A. Coté, B. Joseph Elmunzer

Published in: Surgical Endoscopy | Issue 10/2016

Abstract

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.

Methods

We identified patients with suspected choledocholithiasis hospitalized over a 5-year period (2009–2014) at a tertiary care academic medical center. Among eligible patients, we assessed the performance characteristics of the American Society for Gastrointestinal Endoscopy (ASGE) guidelines predicting the presence of choledocholithiasis, confirmed by endoscopic ultrasound, magnetic resonance cholangiography, ERCP, or intra-operative cholangiography. We also evaluated whether a second set of liver function tests improved the accuracy of the guidelines.

Results

On presentation, 71 of the 173 eligible patients (41.4 %) met ASGE high-probability criteria for choledocholithiasis. Of these, only 39 (54.9 %) were found to have a choledocholithiasis on confirmatory testing. Conversely, of the 102 patients (58.6 %) who were classified as low or intermediate probability, 32 (31.4 %) had choledocholithiasis. Overall, the accuracy of the guidelines was 63 % (sensitivity 54.9 %; specificity 68.6 %). Incorporating a second set of laboratory tests did not improve accuracy (62.7 %), and a significant decline in liver function tests did not reliably predict spontaneous stone passage.

Conclusions

Existing guidelines performed suboptimally for predicting choledocholithiasis in our patient population, similar to other validation studies. These findings further underscore the importance of developing alternate risk stratification tools for choledocholithiasis, aiming to minimize unnecessary diagnostic ERCP.

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Title: An assessment of existing risk stratification guidelines for the evaluation of patients with suspected choledocholithiasis
Authors: Alejandro L. Suarez
Nicolas T. LaBarre
Peter B. Cotton
K. Mark Payne
Gregory A. Coté
B. Joseph Elmunzer
Publication date: 01-10-2016
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 10/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-016-4799-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

An assessment of existing risk stratification guidelines for the evaluation of patients with suspected choledocholithiasis

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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