{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T12:04:56Z","timestamp":1790251496747,"version":"4.1.0"},"reference-count":13,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The American and European Societies of Gastrointestinal Endoscopy (ASGE and ESGE) have published diagnostic guidelines for the evaluation of choledocholithiasis. The applicability and feasibility of these guidelines in a publicly funded health care system, such as ours in Aotearoa New Zealand, are not known. This retrospective study compared the diagnostic performance and utility of these guidelines against our current approach to biliary investigations to explore the feasibility of their local implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We identified patients with biliary diagnosis during 2017 from admission records. We retrospectively applied the diagnostic criteria of the ASGE 2010, ASGE 2019 and ESGE 2019 guidelines to classify patients as low, intermediate or high risk for choledocholithiasis, and to determine their management if the guidelines were followed. We estimated the diagnostic performance of the guidelines using ERCP or IOC as gold standard. The simulated volume and diagnostic yield of biliary investigations according to guidelines were compared to those observed with our current approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included 621 patients, of whom 18% had choledocholithiasis. For diagnosing choledocholithiasis, ASGE 2010, ASGE 2019 and ESGE 2019 guidelines had sensitivities of 79%, 68% and 57% and specificities of 93%, 96% and 97% respectively, if only patients classified as high risk were considered. If patients classified as high or intermediate risk were both considered, their sensitivities increased to &gt;\u200999% at the expense of lower specificities of 20%\u201330%. The AUCs for the guidelines were 0.88, 0.85 and 0.83, respectively. When compared to our current approach to biliary investigations, guideline adoption would double MRCP utilisation with correspondingly decreased diagnostic yield.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Both ASGE and ESGE guidelines for choledocholithiasis may increase the volume of biliary investigations without delivering better diagnostic performance than an ad hoc approach to biliary investigations. Guideline adoption in their current forms cannot be justified in our publicly funded system in Aotearoa New Zealand. Possible contributors to poor guideline performance have been proposed and these will require further research to guide adaptation of the guidelines for our local use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ans.70823","type":"journal-article","created":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T02:16:57Z","timestamp":1783131417000},"page":"2522-2530","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic Guidelines for the Evaluation of Choledocholithiasis in Patients With Acute Biliary Presentations: A Study of Their Applicability and Feasibility in a Publicly Funded Healthcare System"],"prefix":"10.1111","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2799-8777","authenticated-orcid":false,"given":"Henry C. K.","family":"Kwok","sequence":"first","affiliation":[{"name":"Department of Surgery Faculty of Medical and Health Sciences, The University of Auckland \u2010 Te Waipapa Taumata Rau  Auckland New Zealand"},{"name":"Counties Manukau District Health New Zealand \u2010 Te Whatu Ora  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alain C.","family":"Vandal","sequence":"additional","affiliation":[{"name":"Department of Statistics Faculty of Science, The University of Auckland \u2010 Te Waipapa Taumata Rau  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8672-6379","authenticated-orcid":false,"given":"Andrew G.","family":"Hill","sequence":"additional","affiliation":[{"name":"Department of Surgery Faculty of Medical and Health Sciences, The University of Auckland \u2010 Te Waipapa Taumata Rau  Auckland New Zealand"},{"name":"Counties Manukau District Health New Zealand \u2010 Te Whatu Ora  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6255-4792","authenticated-orcid":false,"given":"Andrew D.","family":"MacCormick","sequence":"additional","affiliation":[{"name":"Department of Surgery Faculty of Medical and Health Sciences, The University of Auckland \u2010 Te Waipapa Taumata Rau  Auckland New Zealand"},{"name":"Counties Manukau District Health New Zealand \u2010 Te Whatu Ora  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-199903000-00009"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000103069.00170.9c"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1308\/003588403321661325"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2009.09.041"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2018.10.001"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-0862-0346"},{"key":"e_1_2_12_8_1","unstructured":"R Core Team \u201cR: A Language and Environment for Statistical Computing \u201dVienna Austria; 2024 https:\/\/www.R-project.org\/."},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.2307\/2531595"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v033.i01"},{"key":"e_1_2_12_11_1","unstructured":"R.Tibshirani R.Tibshirani J.Taylor J.Loftus S.Reid andJ.Markovic \u201cselectiveInference: Tools for Post\u2010Selection Inference \u201d2019 cited October 30 2025 https:\/\/CRAN.R-project.org\/package=selectiveInference."},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/wjs.12684"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/osp4.13"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/imj.12624"}],"container-title":["ANZ Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ans.70823","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ans.70823","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ans.70823","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T11:16:22Z","timestamp":1790248582000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ans.70823"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,3]]},"references-count":13,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1111\/ans.70823"],"URL":"https:\/\/doi.org\/10.1111\/ans.70823","archive":["Portico"],"relation":{},"ISSN":["1445-1433","1445-2197"],"issn-type":[{"value":"1445-1433","type":"print"},{"value":"1445-2197","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,3]]},"assertion":[{"value":"2025-12-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-03","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}