Diagnostic performance of ASGE criteria for choledocholithiasis in acute biliary pancreatitis: A retrospective cohort study.

OBJECTIVE

To evaluate the diagnostic performance of the 2019 American Society for Gastrointestinal Endoscopy (ASGE) criteria for choledocholithiasis in patients with acute biliary pancreatitis (ABP).

PATIENTS AND

METHODS

We retrospectively analyzed patients diagnosed with ABP and suspected choledocholithiasis at a tertiary hospital between January and December 2024. Common bile duct (CBD) stones were confirmed by magnetic resonance cholangiopancreatography (MRCP) or computed tomography (CT) followed by endoscopic retrograde cholangiopancreatography (ERCP). Patients were stratified according to ASGE 2019 criteria. Diagnostic accuracy was assessed, and cut-off values for alkaline phosphatase (ALP), total bilirubin (TB), and CBD diameter were determined using receiver operating characteristic (ROC) analysis and logistic regression. Biochemical follow-up was analyzed in intermediate-risk patients without confirmed stones.

RESULTS

A total of 197 patients were included; 52 (26.4%) had confirmed choledocholithiasis. Prevalence was 46.9% in the high-risk group and 22.4% in the intermediate group. High-risk classification showed low sensitivity (28.8%) but high specificity (88.3%). Alkaline phosphatase (ALP) was the only independent predictor (cut-off 518IU/L). In intermediate-risk patients without stones, 95% achieved biochemical normalization within 2 weeks.

CONCLUSIONS

ASGE 2019 criteria overestimate the risk of choledocholithiasis in ABP, particularly in intermediate-risk patients. Early biochemical follow-up may avoid unnecessary imaging and procedures in this group, while ALP remains the most consistent independent predictor. These results support more conservative and cost-effective management strategies in ABP.