Medical Journal of the Islamic Republic Of Iran
مجله پزشکی جمهوری اسلامی ایران
Med J Islam Repub Iran
Medical Sciences
http://mjiri.iums.ac.ir
2
journal2
1016-1430
2251-6840
8
10.18869/mjiri
14
8888
13
en
jalali
1401
11
1
gregorian
2023
2
1
37
1
online
1
fulltext
en
Evaluation of ASGE Criteria for Prediction of Choledocholithiasis: Can Early Endoscopic Ultrasound Utilization Make the Prediction More Accurate?
Gastroenterology and Liver Disease
Gastroenterology and Liver Disease
Original Research: Clinical Science
Original Research: Clinical Science
<div style="text-align: justify;"><span style="font-size:13pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="text-autospace:none"><span new="" roman="" style="font-family:" times=""><span style="font-style:italic"><b><span style="font-size:9.0pt"><span style="font-style:normal">Background: </span></span></b><span style="font-size:9.0pt"><span style="font-style:normal">ASGE predictive model for the detection of choledocholithiasis is a reasonable approach for the management of patients with cholelithiasis. Surgeons do not pursue cholecystectomy without evaluation of the biliary system when laboratory tests and diagnostic imaging evidence show biliary duct involvement. Literature revisions reveal that the prediction of choledocholithiasis based on ASGE criteria suffers from poor accuracy which results in unnecessary ERCPs. We decided to estimate the sensitivity and specificity of the ASGE predictive model for the detection of choledocholithiasis with the hope that early EUS would obviate the need for unnecessary ERCPs among highly probable patients for choledocholithiasis based on ASGE criteria. </span></span></span></span></span></span></span></span><br>
<span style="font-size:13pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="text-autospace:none"><span new="" roman="" style="font-family:" times=""><span style="font-style:italic"><span style="font-size:9.0pt"><span style="font-style:normal"> <b>Methods: </b>This is a prospective intervention and control study on the accuracy of ASGE criteria for the prediction of choledocholithiasis. To evaluate the sensitivity and specificity of ASGE criteria, patients were followed in two groups of controls who were treated based on ASGE guidelines and cases who underwent primary EUS. The clinical relevance of the ASGE criteria was estimated by sensitivity and specificity using SPSS Statistics 28 software. Then, absolute risk reduction utilizing primary EUS was also calculated.</span></span></span></span></span></span></span></span><br>
<span style="font-size:13pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="text-autospace:none"><span new="" roman="" style="font-family:" times=""><span style="font-style:italic"><span style="font-size:9.0pt"><span style="font-style:normal"> <b>Results:</b> The sensitivity and specificity of the ASGE predictive guideline for choledocholithiasis were estimated to be 62.31% and 51.85%, respectively. Evaluation of the ASGE guideline also revealed that patients in the intermediate probability group who finally required ERCP based on EUS results (false-negatives) were estimated to be 49.1% and patients who were predicted to require ERCP but finally did not need ERCP (false positives) were estimated to be 37.68%. The comparison of the two groups revealed the need for ERCP in about 55.56% of the primary EUS group and 77.42% in the ASGE group. Utilization of primary EUS reduced the need for ERCP by an absolute risk reduction of 0.299. (Primary Endpoint)</span></span></span></span></span></span></span></span><br>
<span style="font-size:13pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="text-autospace:none"><span new="" roman="" style="font-family:" times=""><span style="font-style:italic"><span style="font-size:9.0pt"><span style="font-style:normal"> <b>Conclusion: </b>ASGE guideline is associated with the overestimation of ERCP in cholelithiasis. The usage of primary EUS will reduce the need for ERCP.</span></span></span></span></span></span></span></span><br>
</div>
Cholelithiasis, Choledocholithiasis, Cholangiopancreatography, Endoscopic Retrograde (ERCP), Endoscopic Ultrasound (EUS), Pancreatitis, Cholangitis
9
16
http://mjiri.iums.ac.ir/browse.php?a_code=A-10-6508-2&slc_lang=en&sid=1
Amir
Sadeghi
amirsadeghimd@yahoo.com
200319475328460075945
200319475328460075945
No
Research Institute for Gastroenterology and Liver Diseases (RIGLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
Hamid
Asadzadeh Aghdaei
hamid.assadzadeh@gmail.com
200319475328460075946
200319475328460075946
No
Research Institute for Gastroenterology and Liver Diseases (RIGLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
Pardis
Ketabimoghadam
ketabimoghdam.p@sbmu.ac.ir
200319475328460075947
200319475328460075947
Yes
Research Institute for Gastroenterology and Liver Diseases (RIGLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
Khaled
Rahmani
khaledrahmani111@sbmu.ac.ir
200319475328460075948
200319475328460075948
No
Liver and Digestive Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
Mohsen
Rajabnia
dr.rajabnia@outlook.com
200319475328460075949
200319475328460075949
No
Research Institute for Gastroenterology and Liver Diseases (RIGLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
Niloufar
Salehi
nsalehi94@yahoo.com
200319475328460075950
200319475328460075950
No
Medicine Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Seyedayin
Hosseini
ayin.meimand@gmail.com
200319475328460075951
200319475328460075951
No
Medicine Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Seyedeh Melika
Fanaei
fa.melika@yahoo.com
200319475328460075952
200319475328460075952
No
Medicine Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran