How valuable are the esge and asge guidelines for estimating coledocal stones in patients with acute bililary pancreatitis?

AIM: The use of ERCP in acute biliary pancreatitis is usually in the treatment of choledocholithiasis. However, the indications for ERCP in these patients are still controversial. The aim of this study is to reveal the value of the ASGE and ESGE guidelines in predicting choledochal stones in patients hospitalized with the diagnosis of biliary pancreatitis. METHOD: In our study, demographic, clinical and laboratory parameters of the cases hospitalized with the diagnosis of acute biliary pancreatitis in the Gastroenterology clinic of Sakarya University Training and Research Hospital between January 2014 and December 2018 were analyzed retrospectively. RESULTS: 1538 patients were analyzed. According to the ASGE and ESGE criteria, the specificity of the presence of high probability in demonstrating common choledochal stone was 96% and 97.5%, and the positive predictive value (PPD) of ESGE was found to be slightly higher than that of ASGE (83.9% and 79.5%, respectively). The addition of T. Bilirubin >4 mg/dl in ASGE criteria and the addition of common bile duct dilatation criteria in USG increased the specificity >99% and it was determined as the criterion with the highest positive "Likeli hood ratio (LO)" (+LO:22.26) . According to ASGE and ESGE criteria, the specificity of the presence of medium probability is around 40%; the simultaneous common bile duct dilatation in abnormal LFT and USG, which are among the intermediate probability criteria, doubles the specificity in both ASGE and ESGE (98.6% and 95.4%, respectively). CONCLUSION: As a result, it has been determined that the use of ASGE and ESGE high probability criteria for elective ERCP in patients with biliary pancreatitis is beneficial in terms of processing the appropriate patient. Particularly, jaundice and/or elevation of LFT associated with common bile duct dilatation detected on USG has high specificity in terms of estimation of common bile duct stones. Keywords: Acute Pancreatitis, ASGE, ERCP, ESGE, Choledochal stone