Clinical Endoscopy

Original Article

Evaluating the Revised American Society for Gastrointestinal Endoscopy Guidelines for Common Bile Duct Stone Diagnosis: Jake S. Jacob, Michelle E. Lee, Erin Y. Chew, Aaron P. Thrift, Robert J. Sealock; Clin Endosc 2021;54(2):269-274. Published online November 6, 2020; DOI: https://doi.org/10.5946/ce.2020.100

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Background
/Aims: The American Society for Gastrointestinal Endoscopy (ASGE) revised its guidelines for risk stratification of patients with suspected choledocholithiasis. This study aimed to assess the diagnostic performance of the revision and to compare it to the previous guidelines.
Methods
We conducted a retrospective cohort study of 267 patients with suspected choledocholithiasis. We identified high-risk patients according to the original and revised guidelines and examined the diagnostic accuracy of both guidelines. We measured the association between individual criteria and choledocholithiasis.
Results
Under the original guidelines, 165 (62%) patients met the criteria for high risk, of whom 79% had confirmed choledocholithiasis. The categorization had a sensitivity and specificity of 68% and 55%, respectively, for the detection of choledocholithiasis. Under the revised guidelines, 86 (32%) patients met the criteria for high risk, of whom 83% had choledocholithiasis. The revised categorization had a lower sensitivity and higher specificity of 37% and 80%, respectively. The positive predictive value of the high-risk categorization increased with the revision, reflecting a potential decrease in diagnostic endoscopic retrograde cholangiopancreatograpies (ERCPs). Stone visualized on imaging had the greatest specificity for choledocholithiasis. Gallstone pancreatitis was not associated with the risk for choledocholithiasis.
Conclusions
The 2019 revision of the ASGE guidelines decreases the utilization of ERCP as a diagnostic modality and offers an improved risk stratification tool.

Citations

Citations to this article as recorded by

Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography for Bile Duct Stones—Avoiding the Avoidable
Stefan Chiriac, Catalin Sfarti, Horia Minea, Sebastian Zenovia, Irina Girleanu, Laura Huiban, Cristina Muzica, Adrian Rotaru, Remus Stafie, Robert Nastasa, Ermina Stratina, Bogdan Mihnea Ciuntu, Raluca Avram, Anca Trifan
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Unnecessary ERCPs: Is Spontaneous Stone Passage the Sole Determinant?
Dimitrios I. Ziogas, Theodoros A. Voulgaris, Ance Volkanovska, Aliki Stamou, Georgios Kranidiotis, Gerasimos Stefanidis, Paraskevas Gkolfakis, Ioannis A. Vezakis, Gjorgi Deriban, Meri Trajkovska, Konstantinos Triantafyllou, Antonios Vezakis, Ioannis S. Pa
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Endoscopic retrograde cholangiopancreatography, endoscopic papillary balloon dilation, and laparoscopic hepatectomy for intra- and extrahepatic bile duct stones
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Performance of Diagnostic Guidelines in the Evaluation of Choledocholithiasis in Patients With Acute Biliary Presentation: A Systematic Review and Meta‐Analysis
Henry C. K. Kwok, Fransiska R. M. Falconer, Alain C. Vandal, Andrew G. Hill, Andrew D. Maccormick
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ERCP findings provide further justification for a “surgery-first” mindset in choledocholithiasis
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Dynamic changes in liver function tests do not correctly reclassify patients at risk of choledocholithiasis beyond ASGE 2019 criteria
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Criterios ASGE 2010 frente a 2019 para coledocolitiasis en pacientes llevados a colangiopancreatografía retrógrada endoscópica
Ana María Lourido Gamboa, Guillermo Vallejo Vallecilla, Jesús Eduardo Díaz Realpe, Katheryn Daniela Lagos Castro, Juan David Guzmán Sandoval, Angela María Merchán Galvis
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Focused Review Series: Current Status of Image-Enhanced Endoscopy (IEE)

Role of Image-Enhanced Endoscopy in Pancreatobiliary Diseases: Yun Nah Lee, Jong Ho Moon, Hyun Jong Choi; Clin Endosc 2018;51(6):541-546. Published online November 30, 2018; DOI: https://doi.org/10.5946/ce.2018.203

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Recent advances in cholangiopancreatoscopy technology permit image-enhanced endoscopy (IEE) for pancreatobiliary diseases. There are limitations in endoscopy performance and in the study of the clinical role of IEE in bile duct or pancreatic duct diseases. However, currently available IEEs during cholangiopancreatoscopy including traditional dye-aided chromoendoscopy, autofluorescence imaging, narrow-band imaging, and i-Scan have been evaluated and reported previously. Although the clinical role of IEE in pancreatobiliary diseases should be verified in future studies, IEE is a useful promising tool in the evaluation of bile duct or pancreatic duct mucosal lesions.

Citations

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Review

An Update on Endoscopic Management of Post-Liver Transplant Biliary Complications: Hyun Woo Lee, Najmul Hassan Shah, Sung Koo Lee; Clin Endosc 2017;50(5):451-463. Published online April 17, 2017; DOI: https://doi.org/10.5946/ce.2016.139

Abstract PDF PubReader ePub

Biliary complications are the most common post-liver transplant (LT) complications with an incidence of 15%–45%. Furthermore, such complications are reported more frequently in patients who undergo a living-donor LT (LDLT) compared to a deceased-donor LT (DDLT). Most post-LT biliary complications involve biliary strictures, bile leakage, and biliary stones, although many rarer events, such as hemobilia and foreign bodies, contribute to a long list of related conditions. Endoscopic treatment of post-LT biliary complications has evolved rapidly, with new and effective tools improving both outcomes and success rates; in fact, the latter now consistently reach up to 80%. In this regard, conventional endoscopic retrograde cholangiopancreatography (ERCP) remains the preferred initial treatment. However, percutaneous transhepatic cholangioscopy (PTCS) is now central to the management of endoscopy-resistant cases involving complex hilar or multiple strictures with associated stones. Many additional endoscopic tools and techniques—such as the rendezvous method, magnetic compression anastomosis (MCA), and peroral cholangioscopy (POCS)—combined with modified biliary stents have significantly improved the success rate of endoscopic management. Here, we review the current status of endoscopic treatment of post-LT biliary complications and discuss conventional as well as the aforementioned new tools and techniques.

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An Ectopic Opening of the Common Bile Duct into the Duodenal Bulb: The Clinical Features and Endoscopic Treatment: Sang Soo Lim, M.D., Hong Ja Kim, M.D., Du San Baik, M.D., Ki Chul Shin, M.D., Il Han Song, M.D., Young Woo Choi, M.D.*, Jung Ho Han, M.D.^† and Sang Heum Park, M.D.^‡; Korean J Gastrointest Endosc 2010;40(1):16-21. Published online January 30, 2010

Abstract PDF: Background
/Aims: An ectopic opening of the common bile duct (CBD) into the duodenal bulb is known to cause biliary tract diseases or peptic ulcer. Yet such a case is extremely rare and the clinical significance of this malformation has not yet been clarified.
Methods
Ten patients with an ectopic opening in the duodenal bulb and who were treated at 4 hospitals in the Chungcheong province area were enrolled. Their clinical and radiographic features and the treatment for their combined biliary diseases were retrospectively analysed.
Results
The mean age of the ten patients was 73 years (range: 38∼84 years, 8 men, 2 women) Eight of 10 patients had clinical signs and symptoms (RUQ abdominal pain: 5, epigastric pain: 3, fever: 3, Melena: 1). The two patients without symptoms were incidentally found to have an ectopic orifice during the evaluation for bile duct dilatation and a regular health check-up, respectively. Nine had duodenal ulcer scars or bulb deformities. Four had active duodenal ulcers and one of them had bleeding from the active duodenal ulcer, which was treated by endoscopic sclerotheraphy. Six of the 10 patients (60%) had biliary tract diseases (CBD stones: 4, cholangitis without CBD stone: 1, IHD stone: 1). Cholangiography was used for evaluation in 9 patients, and it showed dilatation of the CBD or IHD in 7 (78%), a tapered common bile duct at the distal CBD in 7 (78%) and a hook-shaped distal CBD in 8 (89%). Six patients' biliary tract diseases were treated endoscopically (ERCP: 4, PTCS: 2). Duodenal perforation occurred in 1 (10%), who was successfully managed by medical treatment.
Conclusions
An ectopic opening of the CBD in the duodenal bulb is frequently associated with recurrent duodenal ulcer and biliary tract disease. Combined biliary tract disease can be successfully treated endoscopically. (Korean J Gastrointest Endosc 2010;40:16-21)

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원저 : 담도 췌장 ; 췌담도계 질환에서 관내 내시경 ( Intraductal endoscope ) 의 유용성 ( Original Articles : Biliary Tract & Pancreas ; Usefulness of Intraductal Endoscopy for Pancreaticobiliary Disease ): Korean J Gastrointest Endosc 1997;17(1):32-40. Published online November 30, 1996

Abstract PDF: Background
/Aims: The aim of this study was to evaluate the usefulness of intraductal endoscopy in pancreaticobiliary tract disease by means of percutaneous cholangioscopy(PCS), peroral cholangioscopy(POCS) and peroral pancteatoscopy(POPS). Methods: PCS was performed in 33 patients, including 24 patients with biliary tract stones, and 8 patients with malignant biliary tract disease, and one with villous adenoma of common bile duct(CBD), POCS was performed in 5 patients, including two with cholangiocarcinoma, two with icteric hepatoma and one with benign stenosis of bile duct. POPS performed in 6 patients, ineluding 3 patients with chronic pancreatitis, two with pancreatic cancer and one with mucinous ductal ectasia. Results: 1. Complete removal of the stones was achieved in 22 of 24 patie~nts(91.7%). 2. Accuracy rate of forceps biopsy in PCS was achieved 13 fo 14 patients(92.9%). 3. Success rate of therapeutic PCS was 100%. 4. Accuracy rate of forceps biopsy in POCS was achieved 3 of 5 patients(60%). 5. Diagnostic gain of POPS was achieved 5 of 6 patients(83.3%). 6. There was no serious complications with only mild complications in 3 patients, including mild bleeding in 2 patients and cholangitis in only one. Conclusions: Intraductal endoscopy of biliary tract, including PCS and POCS were useful diagnostic and therapeutic methods with advantages of direct visualization of intraductal disease and POPS using ultrathin pancreatoscope could provide direct assessment of the pancreatic duct. (Korean J Gastrointest Endosc 17: 32-40, 1997)

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