识别可能患有CDL的患者是一个重要的临床难题,因为内镜逆行胰胆管造影术(ERCP),不良事件的风险为5-7%。这项研究的目的是比较2010年和2019年ASGE标准的诊断测试性能,以帮助对可疑CDL患者进行风险分层。
从2013年至2019年连续评估可能的CDL患者从手术中确定,内窥镜,和放射学数据库在一个单一的学术中心。纳入标准包括所有因怀疑CDL而接受ERCP和/或胆囊切除术及术中胆管造影(IOC)的患者。我们从两个指南中计算了标准的诊断测试性能,并使用接收器操作员曲线比较了它们的区别。使用单变量和多变量分析来确定最强的成分预测因子。
1098名患者[年龄57.9±19.0岁,包括62.8%(690)F]。66.3%(728)的患者在ERCP和/或IOC上发现CDL。在使用2019年指南时,灵敏度,特异性,PPV,NPV,精度分别为65.8、78.9、86.3、54.1和70.4%,分别。使用2010年的指导方针,灵敏度,特异性,PPV,NPV,精度分别为50.5、78.9、82.5、44.8和60.1%,分别。使用2019年指南[0.726(0.695,0.758)]的高风险标准的AUC高于2010年指南[0.647(0.614,0.681)]。提供增加辨别的关键区别是在任何成像模式上都包含结石,灵敏度从29.1%提高到55.0%。不包括成像或胆管炎的CDL,在多变量分析中,CBD扩张是CDL的最强个体预测因子(OR3.70,CI2.80,4.89).
与2010年相比,2019年的高风险标准提高了诊断测试性能,但仍然表现不佳。侵入性较小的测试,例如EUS或MRCP,在ERCP之前,对于怀疑有CDL的患者应考虑。
Identifying patients likely to have CDL is an important clinical dilemma because endoscopic retrograde cholangiopancreatography (ERCP), carries a 5-7% risk of adverse events. The purpose of this study was to compare the diagnostic test performance of the 2010 and 2019 ASGE criteria used to help risk stratify patients with suspected CDL.
Consecutive patients evaluated for possible CDL from 2013 to 2019 were identified from surgical, endoscopic, and radiologic databases at a single academic center. Inclusion criteria included all patients who underwent ERCP and/or cholecystectomy with intraoperative cholangiogram (IOC) for suspected CDL. We calculated the diagnostic test performance of criteria from both guidelines and compared their discrimination using the receiver operator curve. Univariate and multivariate analysis was used to identify the strongest component predictors.
1098 patients [age 57.9 ± 19.0 years, 62.8% (690) F] were included. 66.3% (728) were found to have CDL on ERCP and/or IOC. When using the 2019
guidelines, the sensitivity, specificity, PPV, NPV, and accuracy are 65.8, 78.9, 86.3, 54.1, and 70.4%, respectively. Using the 2010
guidelines, the sensitivity, specificity, PPV, NPV, and accuracy are 50.5, 78.9, 82.5, 44.8, and 60.1%, respectively. The AUC for high-risk criteria using the 2019
guidelines [0.726 (0.695, 0.758)] was greater than for the 2010
guidelines [0.647 (0.614, 0.681)]. The key difference providing the increased discrimination was the inclusion of stones on any imaging modality, which increased the sensitivity to 55.0% from 29.1%. Not including CDL on imaging or
cholangitis, a dilated CBD was the strongest individual predictor of CDL on multivariate analysis (OR 3.70, CI 2.80, 4.89).
Compared to 2010, the 2019 high-risk criterion improves diagnostic test performance, but still performs suboptimally. Less invasive tests, such as EUS or MRCP, should be considered in patients with suspected CDL prior to ERCP.