Su1550 PERFORMANCE OF UPDATED ASGE HIGH-RISK CRITERIA FOR CHOLEDOCHOLITHIASIS

Abstract

According to the 2010 American Society of Gastrointestinal Endoscopy (ASGE) guidelines for suspected choledocholithiasis, patients are categorized as high-risk for choledocholithiasis if they have a single very strong predictor (CBD stone on abdominal ultrasound, cholangitis or total bilirubin > 4 mg/dL) or both strong predictors (dilated CBD on ultrasound > 6 mm with gallbladder in situ and total bilirubin between 1.8 and 4 mg/dL). Studies have demonstrated limited accuracy of the 2010 high-risk criteria. The ASGE 2019 guidelines suggest using combination of bilirubin > 4mg/dL and dilated CBD or CBD stone on cross sectional imaging or ascending cholangitis as high-risk criteria. ERCP is recommended for patients with high risk for choledocholithiasis. EUS or MRCP is recommended for intermediate-risk patients. To compare the performance of ASGE 2010 and 2019 guidelines for ERCP use in the patients who meet high-risk criteria for suspected choledocholithiasis. This is a retrospective study conducted in an urban community teaching hospital. During the study period, patients who had ERCP for suspected choledocholithiasis were included. Patients with prior cholecystectomy were excluded. Patient were risk stratified according to the ASGE guidelines in high, intermediate and low risk category for choledocholithiasis. The presence or absence of CBD stone on ERCP was taken as the gold standard. Performance characteristics such as sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated for the ASGE high risk predictors. A total of 98 patients had ERCP for suspected choledocholithiasis. 57% were female and 40% were African American. 76% of the patients met the 2010 high-risk criteria and 84% of these had choledocholithiasis (p=<0.001). 55% of the patients met the 2019 high-risk criteria and 91% of these had choledocholithiasis (p= < 0.001). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of ASGE 2010 high-risk criteria vs ASGE 2019 high-risk criteria were 87% vs 69%, 56% vs 82%, 84% vs 91%, 62% vs 50%, 79% vs 73%, respectively. The ASGE 2019 high-risk criteria are less sensitive but more specific with a higher positive predictive value compared to the ASGE 2010 high-risk criteria. Application of the ASGE 2019 high-risk criteria can minimize unnecessary diagnostic ERCPs.