The use of endoscopic ultrasound in tandem with endoscopic retrograde cholangiopancreatography in the 2019 American Society for Gastrointestinal Endoscopy guideline for patients at high risk of choledocholithiasis can help to avoid diagnostic endoscopic retrograde cholangiopancreatography in individuals without ascending cholangitis

IF 1.4 Q4 GASTROENTEROLOGY & HEPATOLOGY

DEN open Pub Date : 2025-01-22 DOI:10.1002/deo2.70058

Apichet Sirinawasatien, Jiravit Chanchairungcharoen, Thanapon Yaowmaneerat, Jirat Jiratham-opas, Kanokpoj Chanpiwat, Tanyaporn Chantarojanasiri, Siriboon Attasaranya, Kannikar Laohavichitra, Jerasak Wannaprasert, Thawee Ratanachu-ek

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引用次数: 0

Abstract

Objectives

Choledocholithiasis is the leading cause of biliary pancreatitis and biliary sepsis. Endoscopic retrograde cholangiopancreatography (ERCP) is considered a minimally invasive treatment for choledocholithiasis. However, diagnostic ERCP should be avoided. We conducted a prospective trial in high-risk choledocholithiasis patients based on the American Society for Gastrointestinal Endoscopy (ASGE) 2019 criteria to investigate the diagnostic accuracy of the current guideline.

Methods

This multicenter, prospective cohort study included 240 consecutive patients. The primary outcome was the performance of the criteria in predicting choledocholithiasis. The secondary outcome was a percentage reduction in diagnostic ERCP when endoscopic ultrasound was used in tandem with ERCP in individuals without ascending cholangitis.

Results

The overall criteria revealed a positive common bile duct (CBD) stone in 87.1% of patients. Regarding the diagnostic performance of each criterion, ascending cholangitis had a specificity of 67.7% and a positive predictive value (PPV) of 90.2%; total bilirubin >4 mg/dL and dilated CBD had a specificity of 74.2% and a PPV of 55.6%; and CBD stone on ultrasound/cross-sectional imaging had a specificity of 58.1% and a PPV of 89.2%. Of the 138 patients without ascending cholangitis who met the other two high-risk criteria and were sent for EUS first, 21 cases (15.2%) were able to avoid a diagnostic ERCP.

Conclusions

The current ASGE 2019 criteria yield acceptable choledocholithiasis diagnostic accuracy. Using endoscopic ultrasound to confirm CBD stones before ERCP can help almost half of patients with the specific condition of total bilirubin >4 mg/dL and dilated CBD to avoid diagnostic ERCP.

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2019年美国胃肠内镜学会指南中对胆总管结石高危患者联合内镜下逆行胆管造影的使用，有助于避免对无升型胆管炎的个体进行内镜下逆行胆管造影诊断。

目的：胆总管结石是胆道性胰腺炎和胆道性败血症的主要原因。内镜逆行胆管造影术（ERCP）被认为是胆总管结石的微创治疗方法。然而，应避免诊断性ERCP。我们根据美国胃肠内镜学会（ASGE） 2019年的标准，在高风险胆总管结石患者中进行了一项前瞻性试验，以研究现行指南的诊断准确性。方法：这项多中心、前瞻性队列研究包括240例连续患者。主要结果是预测胆总管结石的标准的表现。次要结果是在没有上升性胆管炎的个体中，当内窥镜超声与ERCP联合使用时，诊断性ERCP的百分比降低。结果：总体标准显示总胆管（CBD）结石阳性的患者占87.1%。各指标的诊断表现中，上升型胆管炎的特异性为67.7%，阳性预测值（PPV）为90.2%；总胆红素4mg /dL和扩张型CBD特异性为74.2%，PPV为55.6%；超声/横断面成像对CBD结石的特异性为58.1%，PPV为89.2%。138例无升性胆管炎但符合其他两项高危标准并首先接受EUS检查的患者中，21例（15.2%）能够避免诊断性ERCP。结论：目前的ASGE 2019标准可获得可接受的胆总管结石诊断准确性。在ERCP前使用内镜超声确认CBD结石，可以帮助几乎一半的总胆红素4mg /dL和CBD扩张的患者避免诊断性ERCP。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

DEN open

CiteScore

1.30

自引率

0.00%

发文量