Low Detection Rates of Bile Duct Stones During Endoscopic Treatment for Highly Suspected Bile Duct Stones with No Imaging Evidence of Stones
Low Detection Rates of Bile Duct Stones During Endoscopic Treatment for Highly Suspected Bile Duct Stones with No Imaging Evidence of Stones
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DOI：
10.1007/s10620-022-07773-5
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发表时间：
2022-11-30
影响因子：
3.1
通讯作者：
Tada，Shuji
中科院分区：
文献类型：
--
作者：
Saito，Hirokazu;Iwasaki，Hajime;Tada，Shuji
修订后的美国胃肠内窥镜学会(ASGE)2019年指南提供了疑似胆总管结石(CBDS)的高危标准。目的根据ASGE指南2019评估高危疑似胆总管结石患者经内窥镜逆行胆管胰管造影术(ERCP)中胆管结石的检出率。方法本多中心回顾研究包括1100例连续接受ERCP的可疑胆总管结石患者。结果符合任一标准、标准1、标准2和标准3的患者的CBDS检出率分别为86.0%(946/1100)、93.4%(113/121)和50.0%(106/212)。在符合标准1和2、1和3、2和3以及所有标准的患者中，ERCP中CBDS的确诊率分别为95.1%(490/515)、96.2%(25/26)、55.3%(26/47)和98.4%(186/189)。符合标准1的患者ERCP中CBDS的检出率显著高于无标准1的患者[分别为95.7%(814/85 1)和51.0%(132/2 59，P<； 0.001)]。然而，对于仅有临床预测指标的患者，如胆管炎和总胆红素超过4 mg/dL的扩张的胆总管，行ERCP往往会导致不必要的ERCP。
BackgroundThe revised American Society for Gastrointestinal Endoscopy (ASGE) guideline 2019 provides the high-risk criteria for suspected common bile duct stones (CBDSs).AimsTo evaluate CBDS detection rates during endoscopic retrograde cholangiopancreatography (ERCP) in high-risk patients with suspected CBDSs based on the ASGE guideline 2019.MethodsThis multicenter retrospective study included 1100 consecutive patients who underwent ERCP for suspected CBDSs with any high-risk criteria based on the revised ASGE guideline 2019: Criterion 1, CBDSs on imaging; Criterion 2, clinical ascending cholangitis; and Criterion 3, total bilirubin exceeding 4 mg/dL and dilated common bile duct on imaging. We compared CBDS detection rates during ERCP based on individual and combined high-risk criteria.ResultsThe CBDS detection rates of patients who met any of the criteria, only Criterion 1, and Criteria 2 or 3 were 86.0% (946/1100), 93.4% (113/121), and 50.0% (106/212), respectively. In patients who met Criteria 1 and 2, 1 and 3, 2 and 3, and all criteria, CBDSs were confirmed during ERCP in 95.1% (490/515), 96.2% (25/26), 55.3% (26/47), and 98.4% (186/189), respectively. The CBDS detection rate during ERCP of patients with at least Criterion 1 significantly exceeded that of patients without at least Criterion 1 [95.7% (814/851) vs. 51.0% (132/259), respectively,P< 0.001].ConclusionsPatients with CBDS visualization on imaging have very high CBDS detection rates during ERCP. However, performing ERCP on patients with only clinical predictors, such as cholangitis and dilated CBD with total bilirubin exceeding 4 mg/dL, often results in unnecessary ERCP.