A73 PERFORMANCE OF ASGE AND ESGE CRITERIA FOR RISK STRATIFICATION FOR CHOLEDOCHOLITHIASIS IN A REAL-WORLD SETTING. (4th March 2021)

• Record Type: Journal Article
• Authors: Lei, Y; Wishart, E; Mohamed, R; Forbes, N
• Is Part Of: Journal of the Canadian Association of Gastroenterology. Volume 4(2021)Supplement 1
• Page Start: 38
• Page End: 40
• Publication Date: 2021-03-04
• Subjects: Gastroenterology -- Periodicals; 616.33005
• DOI: 10.1093/jcag/gwab002.071
• Languages: English
• ISSNs: 2515-2084

Abstract

Abstract: Background: Choledocholithiasis (CDL) is a common clinical entity and can lead to serious complications, such as pancreatitis or ascending cholangitis. Endoscopic retrograde cholangio-pancreatography (ERCP) is generally the first-line procedure for definitive management of CDL. ERCP has well-established adverse events. Given the risks, patients can be stratified by likelihood of finding CDL on ERCP, thus potentially avoiding an unnecessary procedure in low probability patients. There are three commonly used criteria for this – the American Society for Gastrointestinal Endoscopy (ASGE) 2010 criteria, the ASGE 2019 criteria, and the European Society of Gastrointestinal Endoscopy (ESGE) 2019 criteria. These criteria use a mixture of biliary imaging, clinical condition, and liver biochemistry to stratify patients into low, intermediate, and high probability for CDL. Aims: To test the performance characteristics of the ASGE 2010, ASGE 2019, and ESGE 2019 criteria for probability of CDL on a real-world sample. Methods: We identified all adult patients who had ERCP done at our local centre for suspected CDL between 2012/01/01 and 2018/10/07. A sample of 1000 cases were chosen. We obtained the patients' pre-procedural liver biochemistries, pre-procedural imaging in the preceding 6 months, and their ERCP reports. We used a semi-automated algorithm to determine confirmation of CDL. We inferred clinical gallstone pancreatitis using the surrogate of serum lipase at or greater than three times upper limit of normal. We could not capture clinical ascending cholangitis from the collected data. We stratified each patient according to the three guidelines and calculated their performance characteristics. Results: After manually reviewing visits with incomplete ERCP or repeat ERCP, we analyzed 879 ERCP visits. There were 622 with stone or sludge found on ERCP. The performance characteristics of the high-probability and intermediate-probability criteria of the three guidelines are listed in the table below. Conclusions: Our results for the 2010 ASGE guidelines high probability patients are in keeping with previous validation studies. There have been only one validation study each of the 2019 ASGE guidelines and the 2019 ESGE guidelines, and our results are different in sensitivity and negative predictive value. Future directions in refining these risk stratification tools are needed, and our project in ongoing in assessing the additional value of trends in liver biochemistry. Funding Agencies: None