Accuracy of the American Society for Gastrointestinal Endoscopy, European Society of Gastrointestinal Endoscopy, and Society of American Gastrointestinal and Endoscopic Surgeons criteria in predicting common bile duct microlithiasis.

Background: Patients with suspected common bile duct stones are classified as high risk (HR), intermediate risk (IR), or low risk (LR) based on the American Society for Gastrointestinal Endoscopy (ASGE), European Society of Gastrointestinal Endoscopy (ESGE), and Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). This study validated common bile duct microlithiasis (CBDM) clinical risk stratification utility.

Methods: We retrospectively reviewed cases of suspected CBDM between November 2017 and May 2024. After liver function tests, ultrasound or computed tomography, all patients were stratified according to ASGE, ESGE, and SAGES into HR, IR, and LR.

Results: Among 269 HR patients, diagnostic accuracy was 61.71% [95% confidence interval (CI): 55.77-67.32] for ASGE, 60.59% (95% CI: 54.65-66.25) for ESGE, and 56.51% (95% CI: 50.53-62.30) for SAGES. In the IR group, CBDM confirmation by endoscopic ultrasound (EUS) or magnetic resonance cholangiopancreatography (MRCP) revealed: under ASGE (n = 108), E US detected CBDM in 52 (no stones: 13) vs. MRCP identified CBDM in 19 (negative: 46), yielding 36.5% sensitivity; for ESGE (n = 93), EUS identified CBDM in 46 (no stones:9) vs. MRCP identified CBDM in 32 (negative: 25) at 69.6% sensitivity; per SAGES (n = 69), in the 43 receiving both modalities, EUS detected CBDM in 37 (no stones: 6) vs. MRCP detected CBDM in 14 (negative: 29) with 37.8% sensitivity.

Conclusion: We validated ASGE, ESGE, and SAGES for CBDM prediction but found suboptimal. EUS demonstrates superior sensitivity over MRCP for IR evaluation.