title: Prospective assessment of consensus criteria for evaluation of patients with suspected choledocholithiasis.
abstract: OBJECTIVE
  American Society for Gastrointestinal Endoscopy (ASGE) guidelines have proposed criteria to stratify patients into low, intermediate and high risk of choledocholithiasis. The criteria include variables that are readily available in clinical practice. The objective of the present study was to prospectively assess the accuracy of these criteria.
  
  
  METHODS
  A prospective observational cohort study was conducted at Beth Israel Deaconess Medical Center. All adult patients referred for endoscopic retrograde cholangiopancreatography (ERCP) with suspected choledocholithiasis were considered for inclusion. ASGE criteria were applied, and each patient was categorized as high, intermediate or low risk for choledocholithiasis. Presence of stone at ERCP served as criteria standard.
  
  
  RESULTS
  During the study period, 402 patients met study inclusion criteria and 336 were reported in the final analysis. Of the 244 patients in the high risk for choledocholithiasis group, 185 were found to have stones at ERCP (75.8%, 95% CI 70.2-80.1%). Of the 92 patients in the intermediate risk for choledocholithiasis group, 45 had stones at ERCP (48.9%, 95% CI 38.8-59.1%); P-value for difference between groups = 0.001. Diagnostic accuracy for choledocholithiasis in the high-risk group was 69.05%, and for the intermediate group was 39.95%. Presence of choledocholithiasis on pre-ERCP imaging (OR: 3.6; 95% CI 2.2-6.0; P < 0.01), and bilirubin >1.8 but <4 mg/dL (OR: 1.69; 95% CI 1.0-2.8; P < 0.04) were the strongest predictors of choledocholithiasis. No additional variable that improved accuracy of ASGE criteria was identified.
  
  
  CONCLUSIONS
  ASGE criteria stratify patients by risk for choledocholithiasis and can be used in routine clinical practice.
authors.affiliation: Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.|Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Sethi
authors.affiliation: Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.|Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Fen
authors.initials: F
authors.lastname: Wang
authors.affiliation: Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.|Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Korson
authors.affiliation: Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.|Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Krishnan
authors.affiliation: Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.|Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Tyler M
authors.initials: TM
authors.lastname: Berzin
authors.affiliation: Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.|Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Ram
authors.initials: R
authors.lastname: Chuttani
authors.affiliation: Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.|Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Pleskow
authors.affiliation: Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.|Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Mandeep S
authors.initials: MS
authors.lastname: Sawhney
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D042883:Choledocholithiasis / Q000175:diagnosis*; D032921:Consensus; D003937:Diagnosis, Differential; D019160:Endosonography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: ERCP; cholangitis; choledocholithiasis; guidelines; jaundice