Evaluating the accuracy of American Society for Gastrointestinal Endoscopy guidelines in patients with acute gallstone pancreatitis with choledocholithiasis

Table 1 Patients categorized as intermediate risk for choledocholithiasis, n = 79

	Number of patients meeting criteria
Dilated common bile duct greater than 6 mm or total bilirubin 1.8-4.0 mg/dL (only one)	22
Abnormal liver biochemical other than bilirubin	73
Age greater than 55 yr	45
Acute gallstone pancreatitis	79

Table 2 Number of criteria met for patients categorized as intermediate risk for choledocholithiasis, n = 79

	Number of patients
1 criterion	0
2 criteria	1
3 criteria	45
4 criteria	33

Table 3 Patients categorized as high risk for choledocholithiasis, n = 77

	Numbers patients meeting criteria
Cholangitis	1
Common bile duct stone on imaging	12
Total Bilirubin greater than 4.0 mg/dL	38
Dilated common bile duct greater than 6 mm and total bilirubin 1.8-4.0 mg/dL	31

Table 4 Number of criteria met for patients categorized as high risk for choledocholithiasis, n = 77

	Number of patients
1 criterion	75
2 criteria	2
3 criteria	0
4 criteria	0

Table 5 Demographics of gallstone pancreatitis patients with intermediate and high risk for choledocholithiasis

	Intermediate risk (n = 79)	High risk (n = 77)	P value
Age (yr) mean ± SD	58.6 ± 19.2	58.1 ± 17.3	0.86
BMI (kg/m2) mean ± SD	29.0 ± 6.83	29.6 ± 9.82	0.05
Female	44 (60%)	45 (58%)	0.95
Race			0.70
White	50 (72%)	51 (68%)
Black	15 (22%)	15 (20%)
Other	4 (6%)	9 (12%)
Charlson Comorbidity Index			0.60
0	17 (23%)	19 (25%)
1 to 2	24 (33%)	20 (26%)
3 to 5	21 (29%)	29 (38%)
6 and above	11 (15%)	9 (12%)
Baseline laboratory
Creatinine (mg/dL) mean ± SD	0.98 ± 0.55	0.94 ± 0.68	0.71
White blood cell count (K/L) mean ± SD	11.4 ± 4.64	12.1 ± 7.27	0.49
Lactate (mmol/L) mean ± SD	1.60 ± 1.33	1.75 ± 1.44	0.63
Lipase (IU/L) mean ± SD	4012 ± 5264	3576 ± 4699	0.60
ALT (IU/L) mean ± SD	241 ± 269	335 ± 324	0.06
AST (IU/L) mean ± SD	232 ± 280	294 ± 269	0.18
Alkaline phosphatase (IU/L) mean ± SD	156 ± 130	196 ± 140	0.07
Total bilirubin (mg/dL) mean ± SD	1.32 ± 0.78	4.04 ± 2.06	< 0.01
Presence of gallstone on imaging	79 (100%)	77 (100%)	0.91
Severity of pancreatitis
Mean BISAP ± SD	0.90 ± 0.91	0.88 ± 0.88	0.90
Modified Atlanta Criteria			0.13
Mild	57 (72%)	63 (83%)
Moderate	21 (27%)	10 (13%)
Severe	1 (1%)	3 (4%)

BMI: Body mass index; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; BISAP: Bedside index of severity in acute pancreatitis.

Table 6 Outcomes of patients with intermediate and high risk for choledocholithiasis

	Intermediate risk (n = 79)			High risk (n = 77)
Outcomes	ERCP first (n = 25)	MRCP first (n = 54)	P value	ERCP first (n = 64)	MRCP first (n = 13)	P value
Mean length of stay (Q1; Q3)	4.00 (2.74; 5.00)	5.00 (4.00; 8.00)	0.02	3.00 (2.54; 5.00)	4.38 (4.00; 6.00)	0.08
30-d readmission (%)	3 (12.0%)	11 (20.8%)	0.53	6 (9.52%)	2 (16.7%)	0.61
1-yr readmission (%)	5 (20.0%)	28 (51.9%)	0.02	19 (29.7%)	7 (53.8%)	0.11
1-yr mortality (%)	0 (0.00%)	1 (1.85%)	0.09	1 (1.56%)	0 (0.00%)	1.00
Pancreas necrosis (%)	2 (8.0%)	18 (33.3%)	0.03	6 (10.7%)	3 (35.0%)	0.19
Days to enteral nutrition (Q1; Q3)	2.00 (1.00; 2.50)	2.50 (1.00; 4.00)	0.16	2.00 (1.00; 2.00)	3.00 (2.00; 4.00)	0.10

ERCP: Endoscopic retrograde cholangiopancreatography; MRCP: Magnetic resonance cholangiopancreatography.

Table 7 Sensitivity and specificity of 2010 American Society for Gastrointestinal Endoscopy guidelines for predicting high risk of choledocholithiasis in patients with acute gallstone pancreatitis

	Choledocholithiasis present	Choledocholithiasis not present
Positive for high risk criteria	61	16
Negative for high risk criteria	29	50

Sensitivity = 67.8%; specificity = 75.8%.

Table 8 Sensitivity and specificity of 2010 American Society for Gastrointestinal Endoscopy guidelines for predicting intermediate risk of choledocholithiasis in patients with acute gallstone pancreatitis

	Choledocholithiasis present	Choledocholithiasis not present
Positive for intermediate risk criteria	29	50
Negative for intermediate risk criteria	61	16

Sensitivity = 82.9%; specificity = 24.2%.

Table 9 Sensitivity and specificity of 2019 American Society for Gastrointestinal Endoscopy guidelines for predicting high risk of choledocholithiasis in patients with acute gallstone pancreatitis

	Choledocholithiasis present	Choledocholithiasis not present
Positive for intermediate risk criteria	34	8
Negative for intermediate risk criteria	55	59

Sensitivity = 38.2%; specificity = 88.1%.

Table 10 Sensitivity and specificity of 2019 American Society for Gastrointestinal Endoscopy guidelines for predicting intermediate risk of choledocholithiasis in patients with acute gallstone pancreatitis

	Choledocholithiasis present	Choledocholithiasis not present
Positive for intermediate risk criteria	55	59
Negative for intermediate risk criteria	34	8

Sensitivity = 61.8%; specificity = 11.9%.