LETTERS TO THE EDITOR

 

Accuracy of ASGE criteria for the prediction of choledocholithiasis

 

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Key words: Choledocholithiasis. ERCP. EUS. MRC.

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Dear Editor,

I read with interest the article "Accuracy of ASGE criteria for the prediction of choledocholithiasis" by Nárvaez et al. (1). Patients with suspicion of choledocholithiasis (CL) were categorized according to the American Society for Gastrointestinal Endoscopy (ASGE) recommendations. Those patients classified into high or intermediate-probability for CL underwent an endoscopic retrograde cholangiopancreatography (ERCP) without any further non-endoscopic biliary imaging modalities. In the ASGE recommendations for intermediate risk CL patients, they mention options for the evaluation of these patients including endoscopic ultrasound (EUS) and magnetic resonance cholangiography (MRC) (2). It came to my attention that, in this prospective study, if patients in the intermediate risk group had been offered EUS or MRC prior to the ERCP, the accuracy in this group would had been better than the 41% reported, avoiding unnecessary ERCPs. Also, Adam et al., in the retrospective paper cited by Nárvaez, mention that patients classified as intermediate are best suited for a less invasive initial test, such as EUS, MRC, and intraoperative cholangiography (IOC) (3).

 

Jacobo Dib Jr
Gastroenterology Service. Hospital de Lidice. Caracas, Venezuela

 

References

1. Nárvaez Rivera RM, González González JA, Monreal Robles R, et al. Accuracy of ASGE criteria for the prediction of choledocholithiasis. Rev Esp Enferm Dig 2016;108(6):309-14. DOI: 10.17235/reed.2016.4212/2016.         [ Links ]

2. ASGE Standards of Practice Committee, Maple JT, Ben-Menachem T, et al. The role of endoscopy in the evaluation of suspected choledocholithiasis. Gastrointest Endosc 2010;71(1):1-9. DOI: 10.1016/j.gie.2009.09.041.         [ Links ]

3. Adams MA, Hosmer AE, Wamsteker EJ, et al. Predicting the likelihood of a persistent bile duct stone in patients with suspected choledocholithiasis: Accuracy of existing guidelines and the impact of laboratory trends. Gastrointest Endosc 2015;82:88-93. DOI: 10.1016/j.gie.2014.12.023.         [ Links ]