From the Research
ASGE Risk Stratification
The American Society for Gastrointestinal Endoscopy (ASGE) has developed a risk stratification system to predict the likelihood of choledocholithiasis in patients. This system categorizes patients into low, intermediate, and high risk based on certain criteria.
Criteria for Risk Stratification
The criteria for risk stratification include:
- Liver function tests (LFT) and abdominal ultrasound results 1
- Presence of choledocholithiasis on pre-ERCP imaging 2
- Bilirubin levels 2
- Clinical parameters such as common bile duct stone (CBDS) visualized on imaging, CBDS plus dilated common bile duct, CBDS plus cholangitis, and CBDS plus total bilirubin level > 1.7 mg/dL 3
Validation of ASGE Criteria
Studies have validated the clinical utility of ASGE criteria for predicting choledocholithiasis. For example, one study found that the ASGE criteria had a specificity of 96.87% and a positive predictive value (PPV) of 89.57% for choledocholithiasis 1. Another study found that the ASGE criteria had a diagnostic accuracy of 75% for predicting choledocholithiasis 3.
Comparison with Other Guidelines
The ASGE criteria have been compared with other guidelines, such as the European Society of Gastrointestinal Endoscopy (ESGE) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) guidelines. One study found that the ESGE criteria were more specific than the ASGE criteria for predicting choledocholithiasis 1. Another study found that the SAGES, ASGE, and ESGE criteria had acceptable diagnostic accuracy for choledocholithiasis, but the SAGES criteria had the highest diagnostic accuracy 3.
Limitations and Future Directions
While the ASGE criteria have been validated for predicting choledocholithiasis, there are limitations to the current system. For example, one study found that the ASGE-grading system for ERCP procedures showed poor performance in predicting adverse events 4. Further research is needed to improve the ASGE criteria and to validate the system for extrapolation to other endoscopy units.