title: Accuracy of ASGE criteria for the prediction of choledocholithiasis.
abstract: OBJECTIVE
  Few studies have validated the performance of guidelines for the prediction of choledocholithiasis (CL). Our objective was to prospectively assess the accuracy of the American Society for Gastrointestinal Endoscopy (ASGE) guidelines for the identification of CL.
  
  
  METHODS
  A two-year prospective evaluation of patients with suspected CL was performed. We evaluated the ASGE guidelines and its component variables in predicting CL.
  
  
  RESULTS
  A total of 256 patients with suspected CL were analyzed. Of the 208 patients with high-probability criteria for CL, 124 (59.6%) were found to have a stone/sludge at endoscopic retrograde cholangiopancreatography (ERCP). Among 48 patients with intermediate-probability criteria, 21 (43.8%) had a stone/sludge. The performance of ASGE high- and intermediate-probability criteria in our population had an accuracy of 59.0% (85.5% sensitivity, 24.3% specificity) and 41.0% (14.4% sensitivity, 75.6% specificity), respectively. The mean ERCP delay time was 6.1 days in the CL group and 6.4 days in the group without CL, p = 0.638. The presence of a common bile duct (CBD) > 6 mm (OR 2.21; 95% CI, 1.20-4.10), ascending cholangitis (OR 2.37; 95% CI, 1.01-5.55) and a CBD stone visualized on transabdominal US (OR 3.33; 95% CI, 1.48-7.52) were stronger predictors of CL. The occurrence of biliary pancreatitis was a strong protective factor for the presence of a retained CBD stone (OR 0.30; 95% CI, 0.17-0.55).
  
  
  CONCLUSIONS
  Irrespective of a patient's ASGE probability for CL, the application of current guidelines in our population led to unnecessary performance of ERCPs in nearly half of cases.
authors.affiliation: Gastroenterología, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, México.
authors.forename: Rodrigo Manuel
authors.initials: RM
authors.lastname: Nárvaez Rivera
authors.affiliation: Gastroenterología, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, México.
authors.forename: José Alberto
authors.initials: JA
authors.lastname: González González
authors.affiliation: Gastroenterología, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, México.
authors.forename: Roberto
authors.initials: R
authors.lastname: Monreal Robles
authors.affiliation: Gastroenterología, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, México.
authors.forename: Diego
authors.initials: D
authors.lastname: García Compean
authors.affiliation: Gastroenterología, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, México.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Paz Delgadillo
authors.affiliation: Gastroenterología, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, México.
authors.forename: Aldo Azael
authors.initials: AA
authors.lastname: Garza Galindo
authors.affiliation: Gastroenterología, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, México.
authors.forename: Héctor Jesús
authors.initials: HJ
authors.lastname: Maldonado Garza
mesh_terms: D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000706:statistics & numerical data; D042883:Choledocholithiasis / Q000000981:diagnostic imaging*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000175:diagnosis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results