{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T21:35:00Z","timestamp":1780522500028,"version":"3.54.1"},"reference-count":42,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2023,12,15]],"date-time":"2023-12-15T00:00:00Z","timestamp":1702598400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Up to one-third of patients with acute biliary pancreatitis also present with choledocholithiasis. Guidelines from the European Society of Gastrointestinal Endoscopy (ESGE) and the American Society for Gastrointestinal Endoscopy (ASGE) for investigating suspected choledocholithiasis suggest endoscopic retrograde cholangiopancreatography in patients with high-likelihood (ESGE)\/high-probability (ASGE) predictors and endoscopic ultrasound in those with intermediate-likelihood (ESGE)\/intermediate-probability (ASGE) predictors. Although both guidelines are similar, they are not identical. Furthermore, these algorithms were mainly developed from cohorts of patients without pancreatitis and are therefore poorly validated in a subset of patients with acute pancreatitis. We aimed to assess the performance of the ESGE and ASGE algorithms for the prediction of choledocholithiasis in patients with acute biliary pancreatitis. Materials and Methods: This was a retrospective analysis of 86 consecutive patients admitted to a tertiary referral centre in the year 2020 due to acute biliary pancreatitis. Results: Choledocholithiasis was confirmed in 29\/86 (33.7%) of patients (13 with endoscopic retrograde cholangiopancreatography and 16 with endoscopic ultrasound). All 10\/10 (100%) ESGE high-likelihood and 14\/19 (73.7%) ASGE high-probability patients had choledocholithiasis. Only 19\/71 (26.8%) patients with ESGE intermediate likelihood and 15\/67 (22.4%) with ASGE intermediate probability had choledocholithiasis. Only 8\/13 (61.5%) patients with the ASGE high-probability predictor of dilated common bile duct plus bilirubin &gt; 68.4 \u00b5mol\/mL had choledocholithiasis. Since this predictor is not considered high likelihood by ESGE, this resulted in a superior specificity of the European compared to the American guideline (100% vs. 91.2%). Following the American instead of the European guidelines would have resulted in five unnecessary endoscopic retrograde cholangiopancreatographies and five unnecessary endoscopic ultrasound examinations. Conclusions: This retrospective analysis suggests that the European guidelines may perform better than the American guidelines at predicting choledocholithiasis in the setting of acute pancreatitis. This was because dilated common bile duct plus bilirubin &gt; 68.4 \u00b5mol\/mL was not a reliable predictor for persistent bile duct stones.<\/jats:p>","DOI":"10.3390\/medicina59122176","type":"journal-article","created":{"date-parts":[[2023,12,15]],"date-time":"2023-12-15T03:16:33Z","timestamp":1702610193000},"page":"2176","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Performance of European and American Societies of Gastrointestinal Endoscopy Guidelines for Prediction of Choledocholithiasis in Patients with Acute Biliary Pancreatitis"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1320-7564","authenticated-orcid":false,"given":"\u017dan Peter","family":"\u010cerne","sequence":"first","affiliation":[{"name":"Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nejc","family":"Sever","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, University Medical Centre Ljubljana, Japljeva 2, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luka","family":"Strni\u0161a","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, University Medical Centre Ljubljana, Japljeva 2, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5646-6008","authenticated-orcid":false,"given":"Samo","family":"Plut","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, University Medical Centre Ljubljana, Japljeva 2, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Drnov\u0161ek","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia"},{"name":"Department of Gastroenterology, University Medical Centre Ljubljana, Japljeva 2, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3158-8014","authenticated-orcid":false,"given":"Jurij","family":"Han\u017eel","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, University Medical Centre Ljubljana, Japljeva 2, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darko","family":"Siuka","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, University Medical Centre Ljubljana, Japljeva 2, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Borut","family":"\u0160tabuc","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia"},{"name":"Department of Gastroenterology, University Medical Centre Ljubljana, Japljeva 2, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2734-675X","authenticated-orcid":false,"given":"David","family":"Drobne","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia"},{"name":"Department of Gastroenterology, University Medical Centre Ljubljana, Japljeva 2, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1332","DOI":"10.1016\/j.pan.2020.09.011","article-title":"Acute pancreatitis: 31-Year trends in incidence and mortality\u2014A Danish population-based cohort study","volume":"20","author":"Knudsen","year":"2020","journal-title":"Pancreatology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1016\/S1542-3565(04)00355-6","article-title":"Trends in incidence of acute pancreatitis in a Swedish population: Is there really an increase?","volume":"2","author":"Lindkvist","year":"2004","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.pan.2017.01.005","article-title":"The incidence and aetiology of acute pancreatitis across Europe","volume":"17","author":"Roberts","year":"2017","journal-title":"Pancreatology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1038\/nrgastro.2010.114","article-title":"Etiology and diagnosis of acute biliary pancreatitis","volume":"7","author":"Bhagirath","year":"2010","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1056\/NEJM197402282900904","article-title":"Gallstone Migration as a Cause of Acute Pancreatitis","volume":"290","author":"Acosta","year":"1974","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1308\/003588403321661325","article-title":"Spontaneous passage of bile duct stones: Frequency of occurrence and relation to clinical presentation","volume":"85","author":"Tranter","year":"2003","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1007\/BF01072962","article-title":"The usefulness of stool screening for diagnosing cholelithiasis in acute pancreatitis: A description of the technique","volume":"22","author":"Acosta","year":"1977","journal-title":"Dig. Dis. Sci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.gie.2014.12.023","article-title":"Predicting the likelihood of a persistent bile duct stone in patients with suspected choledocholithiasis: Accuracy of existing guidelines and the impact of laboratory trends","volume":"82","author":"Adams","year":"2015","journal-title":"Gastrointest. Endosc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"16544","DOI":"10.3748\/wjg.v20.i44.16544","article-title":"Imaging tests for accurate diagnosis of acute biliary pancreatitis","volume":"20","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1067\/mge.2003.149","article-title":"EUS for suspected choledocholithiasis: Do benefits outweigh costs? A prospective, controlled study","volume":"57","author":"Buscarini","year":"2003","journal-title":"Gastrointest. Endosc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2566","DOI":"10.1007\/s00464-022-09744-3","article-title":"Magnetic resonance cholangiopancreatography versus endoscopic ultrasound for diagnosis of choledocholithiasis: An updated systematic review and meta-analysis","volume":"37","author":"Afzalpurkar","year":"2023","journal-title":"Surg. Endosc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1007\/s002610000108","article-title":"Choledocholithiasis: Role of US and endoscopic ultrasound","volume":"26","author":"Vilgrain","year":"2001","journal-title":"Abdom. Imaging"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1097\/MEG.0b013e3283460129","article-title":"Endoscopic ultrasonography versus endoscopic retrograde cholangiopancreatography in acute biliary pancreatitis: A systematic review","volume":"23","author":"Leandro","year":"2011","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/j.gie.2021.08.024","article-title":"Cost-effectiveness analysis of optimal diagnostic strategy for patients with symptomatic cholelithiasis with intermediate probability for choledocholithiasis","volume":"95","author":"Ali","year":"2022","journal-title":"Gastrointest. Endosc."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1016\/j.gie.2010.07.047","article-title":"Nationwide, population-based data from 11,074 ERCP procedures from the Swedish Registry for Gallstone Surgery and ERCP","volume":"72","author":"Enochsson","year":"2010","journal-title":"Gastrointest. Endosc."},{"key":"ref_16","first-page":"CD009779","article-title":"Early routine endoscopic retrograde cholangiopancreatography strategy versus early conservative management strategy in acute gallstone pancreatitis","volume":"5","author":"Tse","year":"2012","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.4240\/wjgs.v14.i11.1179","article-title":"Diagnosis, severity stratification and management of adult acute pancreatitis-current evidence and controversies","volume":"14","author":"Chan","year":"2022","journal-title":"World J. Gastrointest. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.gie.2009.09.041","article-title":"The role of endoscopy in the evaluation of suspected choledocholithiasis","volume":"71","author":"Maple","year":"2010","journal-title":"Gastrointest. Endosc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1016\/j.gie.2018.10.001","article-title":"ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis","volume":"89","author":"Buxbaum","year":"2019","journal-title":"Gastrointest. Endosc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1016\/j.dld.2013.02.005","article-title":"Endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis: Testing the current guidelines","volume":"45","author":"Rubin","year":"2013","journal-title":"Dig. Liver Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"128","DOI":"10.4253\/wjge.v7.i2.128","article-title":"Endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis: From guidelines to clinical practice","volume":"7","year":"2015","journal-title":"World J. Gastrointest. Endosc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1055\/a-0862-0346","article-title":"Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline","volume":"51","author":"Manes","year":"2019","journal-title":"Endoscopy"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1056\/NEJM198701153160306","article-title":"The Cell Biology of Experimental Pancreatitis","volume":"316","author":"Flier","year":"1987","journal-title":"N. Engl. J. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1159\/000069146","article-title":"Incidence, etiology, and impact of fever in patients with acute pancreatitis","volume":"3","author":"Bohidar","year":"2003","journal-title":"Pancreatology"},{"key":"ref_25","unstructured":"Charcot, J.M. (1877). Recueillies et Publli\u00e9es par Bourneville et Sevestre, Bureaux du Progr\u00e9s M\u00e9dical & Adrien Delahaye."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1002\/bjs.1800710324","article-title":"The urgent diagnosis of gallstones in acute pancreatitis: A prospective study of three methods","volume":"71","author":"Neoptolemos","year":"2005","journal-title":"Br. J. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1136\/gutjnl-2012-302779","article-title":"Classification of acute pancreatitis\u20142012: Revision of the Atlanta classification and definitions by international consensus","volume":"62","author":"Banks","year":"2013","journal-title":"Gut"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1002\/jhbp.512","article-title":"Tokyo Guidelines 2018: Diagnostic criteria and severity grading of acute cholangitis (with videos)","volume":"25","author":"Kiriyama","year":"2018","journal-title":"J. Hepato-Biliary Pancreat."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1692","DOI":"10.3748\/wjg.v28.i16.1692","article-title":"Evaluating the accuracy of American Society for Gastrointestinal Endoscopy guidelines in patients with acute gallstone pancreatitis with choledocholithiasis","volume":"28","author":"Tintara","year":"2022","journal-title":"World J. Gastroenterol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1016\/j.gie.2017.01.039","article-title":"Accuracy of ASGE high-risk criteria in evaluation of patients with suspected common bile duct stones","volume":"86","author":"He","year":"2017","journal-title":"Gastrointest. Endosc."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1002\/1097-0142(1950)3:1<32::AID-CNCR2820030106>3.0.CO;2-3","article-title":"Index for rating diagnostic tests","volume":"3","author":"Youden","year":"1950","journal-title":"Cancer"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1053\/j.gastro.2018.01.032","article-title":"American Gastroenterological Association Institute Guideline on Initial Management of Acute Pancreatitis","volume":"154","author":"Crockett","year":"2018","journal-title":"Gastroenterology"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1400","DOI":"10.1038\/ajg.2013.218","article-title":"American College of Gastroenterology Guideline: Management of Acute Pancreatitis","volume":"108","author":"Tenner","year":"2013","journal-title":"Am. J. Gastroenterol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1097\/01.sla.0000194086.22580.92","article-title":"Early Ductal Decompression Versus Conservative Management for Gallstone Pancreatitis With Ampullary Obstruction: A Prospective Randomized Clinical Trial","volume":"243","author":"Acosta","year":"2006","journal-title":"Ann. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1653","DOI":"10.1023\/A:1026687632370","article-title":"Repetitive Short-Term Obstructions of the Common Bile\u2013Pancreatic Duct Induce Severe Acute Pancreatitis in the Opossum","volume":"44","author":"Kaiser","year":"1999","journal-title":"Dig. Dis. Sci."},{"key":"ref_36","first-page":"326","article-title":"The theory of \u2018persisting\u2019 common bile duct stones in severe gallstone pancreatitis","volume":"71","author":"Neoptolemos","year":"1989","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1534","DOI":"10.1136\/gutjnl-2022-328258","article-title":"Patient selection for urgent endoscopic retrograde cholangio-pancreatography by endoscopic ultrasound in predicted severe acute biliary pancreatitis (APEC-2): A multicentre prospective study","volume":"72","author":"Hallensleben","year":"2023","journal-title":"Gut"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/S0140-6736(20)30539-0","article-title":"Urgent endoscopic retrograde cholangiopancreatography with sphincterotomy versus conservative treatment in predicted severe acute gallstone pancreatitis (APEC): A multicentre randomised controlled trial","volume":"396","author":"Schepers","year":"2020","journal-title":"Lancet"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"4613","DOI":"10.1007\/s00464-016-4799-8","article-title":"An assessment of existing risk stratification guidelines for the evaluation of patients with suspected choledocholithiasis","volume":"30","author":"Suarez","year":"2016","journal-title":"Surg. Endosc."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1055\/a-1717-1391","article-title":"Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline","volume":"54","author":"Bronswijk","year":"2022","journal-title":"Endoscopy"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"8","DOI":"10.4103\/2303-9027.117764","article-title":"Endoscopic ultrasound elastography","volume":"1","year":"2012","journal-title":"Endosc. Ultrasound"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1055\/a-1075-4080","article-title":"ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline","volume":"52","author":"Dumonceau","year":"2020","journal-title":"Endoscopy"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/12\/2176\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:39:10Z","timestamp":1760132350000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/12\/2176"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,15]]},"references-count":42,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["medicina59122176"],"URL":"https:\/\/doi.org\/10.3390\/medicina59122176","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,15]]}}}