title: ASGE guidelines result in cost-saving in the management of choledocholithiasis.
abstract: BACKGROUND
  The goal of this study was to determine whether utilization of the ASGE guidelines for the evaluation of bile duct stones (BDS) would result in fewer imaging studies and in turn lead to a lower healthcare expenditure.
  
  
  METHODS
  This was a retrospective study set in an urban Teaching Hospital. Patients undergoing evaluation for BDS and who had their gallbladders in situ were included in the study. Data with regard to age, sex, clinical history, pain level, vital signs and laboratory studies as well as diagnostic tests performed were extracted from the hospital's electronic medical record. The ASGE guidelines were applied retrospectively to each patient in the study group and the group was divided into two cohorts: one that followed the ASGE guidelines and one which did not. Patients in the two cohorts were further stratified into high-, intermediate-, and low-risk categories.
  
  
  RESULTS
  Thirty-eight patients met the criteria and were included in the study. Of the 38 patients, 22 were managed as per the ASGE guidelines and 16 were not. Twenty-seven patients were categorized as high-risk (14 following the correct algorithm, 13 not) and 11 as intermediate-risk (8 following, 3 not). There were no low-risk patients. Twelve of the 27 patients in the high-risk group had stones (56%) while 6 of 11 (55%) had stones in the intermediate-risk group. Fourteen computed tomography scans and 12 magnetic resonance cholangiopancreatographies were deemed inappropriate resulting in unnecessary increased expenditure of $ 22,236.
  
  
  CONCLUSIONS
  The application of ASGE guidelines can minimize redundant investigations and effect cost saving but need to be refined to produce a better yield.
authors.affiliation: Department of Medicine, Mount Sinai Services at Elmhurst, Elmhurst General Hospital, Elmhurst, N.Y. and Mount Sinai School of Medicine of the City University of New York, New York, USA.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Singhvi
authors.affiliation: Department of Medicine, Mount Sinai Services at Elmhurst, Elmhurst General Hospital, Elmhurst, N.Y. and Mount Sinai School of Medicine of the City University of New York, New York, USA.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Ampara
authors.affiliation: Department of Medicine, Mount Sinai Services at Elmhurst, Elmhurst General Hospital, Elmhurst, N.Y. and Mount Sinai School of Medicine of the City University of New York, New York, USA.
authors.forename: Joel
authors.initials: J
authors.lastname: Baum
authors.affiliation: Department of Medicine, Mount Sinai Services at Elmhurst, Elmhurst General Hospital, Elmhurst, N.Y. and Mount Sinai School of Medicine of the City University of New York, New York, USA.
authors.forename: Vivek
authors.initials: V
authors.lastname: Gumaste
keywords: ASGE guidelines; ERCP; choledocholithiasis