Diagnostic performance of the current risk-stratified approach with computed tomography for suspected choledocholithiasis and its options when negative finding

作     者：Hyun Woo Lee Tae Jun Song Do Hyun Park Sang Soo Lee Dong-Wan Seo Sung Koo Lee Myung-Hwan Kim Jae Hyuck Jun Ji Eun Moon Yeon Han Song 

作者机构：Digestive Disease Center and Research InstituteDepartment of Internal MedicineSoonchunhyang University School of MedicineBucheonKorea Division of GastroenterologyDepartment of Internal MedicineUniversity of Ulsan College of MedicineAsan Medical CenterSeoulKorea Division of GastroenterologyDepartment of Internal MedicineUniversity of Eulji College of MedicineEulji Medical CenterDaejeonKorea Department of BiostatisticsClinical trial centerSoonchunhyang University Bucheon HospitalBucheonKorea 

出 版 物：《Hepatobiliary & Pancreatic Diseases International》 (国际肝胆胰疾病杂志（英文版）)

年 卷 期：2019年第18卷第4期

页      面：366-372页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

基　　金：Soonchunhyang University Bucheon Hospital 

主　　题：Choledocholithiasis ASGE guideline Accuracy Endoscopic ultrasound Magnetic resonance cholangiopancreatography 

摘      要：Background:Several studies evaluated the current guideline of the American Society for Gastrointestinal Endoscopy(ASGE)and reported only suboptimal *** study evaluated the diagnostic performance of the ASGE guideline based on computed tomography(CT)and role of endoscopic ultrasonography(EUS)and magnetic resonance cholangiopancreatography(MRCP)in patients with suspected choledocholithiasis but negative CT ***:Patients with suspected choledocholithiasis undergoing ERCP between January 2016 and January 2017 were retrospectively *** patients underwent CT to detect *** or MRCP was performed when the CT scan showed negative *** were classified into the high and intermediate-risk groups,based on predictors from the ASGE ***:Of 583 patients with suspected choledocholithiasis,340(58.3%)had stones on ERCP(65.9%in the high-risk group and 40.6%in the intermediate-risk group).The accuracy of ASGE guideline for CT was 63.98%(79.12%sensitivity,42.80%specificity)and 36.02%(20.88%sensitivity,57.20%specificity)in the high-risk and intermediate-risk groups,*** 103 patients in the high-risk group underwent both CT and US,the accuracy of CT was higher than that of US for detecting choledocholithiasis(78.64%vs.53.40%),with a significant difference in area under the curve(AUC)(0.78 vs.0.59,P0.001).Of 339 with negative CT finding,the accuracy of EUS was higher than that of MRCP(90.91%vs.82.76%),but with no significant difference in AUC(0.91 vs.0.83,P=0.347).Conclusions:CT-based ASGE guideline showed superior diagnostic performance than US for predicting *** diagnostic options,EUS or MRCP,with negative CT finding showed comparable ***,the diagnostic modality should be selected based on availability,experience,cost,and contraindications.