| Objective:Common bile duct stones is a common clinical condition,and the American Society of Gastrointestinal Endoscopy(ASGE)and the European Society of Gastrointestinal Endoscopy(ESGE)stratify patients with suspected common bile duct stones by risk based on liver function and imaging findings in 2019.However,when in patients with highly suspicious common bile duct stones but negative CT,there is no clear consensus on the follow-up approach.Endoscopic ultrasound(EUS)is considered to be a more accurate tool for the diagnosis of common bile duct stones,with fewer complications associated with the procedure and at a lower cost than magnetic resonance cholangiopancreatography(MRCP).Therefore,we aimed to investigate the value of comparing the latest guideline stratification criteria published by the two societies for clinical practice application and the value of EUS for the diagnosis of patients with suspected common bile duct stones but negative CT.Methods: Retrospective analysis Patients with suspected common bile duct stones attending Shengjing Hospital of China Medical University from November 2019 to July2022 were included,and risk stratification of included patients was performed according to ASGE and ESGE criteria.The results of laparoscopic common bile duct exploration(LCBDE)or endoscopic retrograde cholangiopancreatography/endoscopicsphincterotomy(ERCP/EST)were used as the gold standard.The diagnostic efficacy of the guidelines was assessed by comparing the area under the ROC curve,and their ability to predict common bile duct stones was judged by calculating the OR of individual risk factors.The ability of EUS,US,and CT in the diagnosis of common bile duct stones was assessed by calculating sensitivity,specificity,positive predictive value,negative predictive value,accuracy,and comparing the area under the ROC curve.Patients who had undergone both EUS and MRCP were screened among those with CT-negative suspected common bile duct stones for analysis,and the diagnostic efficacy was compared between MRCP and EUS by the above method.Results: A total of 344 patients were included in this study,and 205 patients(70.52%)were diagnosed with common bile duct stones using ERCP/EST or LCBDE results as the gold standard.For the high-risk group,the diagnostic accuracy of ASGE and ESGE high-risk criteria was 75.29%(sensitivity 72.68%,specificity 79.14%)and 74.71%(sensitivity 70.73%,specificity 80.58%),respectively.The equivalent areas under the subject working characteristic curves for the two guidelines were 0.759(95% confidence interval [CI]: 0.710 to 0.803)and 0.757(95% CI: 0.708 ～0.801),respectively.Among the separate risk factors,imaging was found to be the highest risk factor for common bile duct stones(OR=11.988;95% CI: 6.876 ～ 20.898).All patients included underwent US,CT,and EUS during the same hospitalization.The sensitivity,specificity,and accuracy were: US(38.54%,94.24%,61.05%),CT(55.12%,88.49%,68.6%),and EUS(95.61%,90.65%,93.6%),respectively,with AUCs of: 0.664(95% CI,0.611 ～ 0.714),0.718(95%CI,0.667 ～0.765),and 0.931(95% CI,0.899～0.956),with statistically significant differences between the two comparisons(P<0.05).In 172 patients who underwent both EUS and MRCP,the sensitivity of the two for detecting common bile duct stones was92.66% and 81.65%,and the specificity was 95.24% and 96.83%,respectively,with AUCs of 0.939(95% CI: 0.893-0.970)and 0.892(95% CI: 0.836-0.934),respectively,and the differences were not statistically significant(P= 0.0520).In 108 patients with negative CT who underwent both EUS and MRCP,the sensitivity and specificity of the two tests were 85.11% and 69.96%,respectively,and 95.08% and 96.72%,respectively,with AUCs of 0.901(95% CI: 0.828-0.950)and 0.813(95% CI: 0.727-0.882),respectively,for the detection of common bile duct stones.0.882),and the differences were statistically significant(P < 0.05).Conclusion: The existing guidelines have better diagnostic ability in the population with suspected common bile duct stones,but still cause about 1/3 of patients to undergo unnecessary ERCP examinations.Both EUS and MRCP are more accurate tools in the diagnosis of common bile duct stones,but the overall diagnostic efficacy of EUS is better than MRCP in the case of negative CT,and EUS examination can be preferred in the absence of significant contraindications. |
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