Performance of diagnostic tools for acute cholangitis in patients with suspected biliary obstruction

Christina J. Sperna Weiland*, Celine B.E. Busch, the Dutch Pancreatitis Study Group, Abha Bhalla, Marco J. Bruno, Paul Fockens, Jeanin E. van Hooft, Alexander C. Poen, Hester C. Timmerhuis, Devica S. Umans, Niels G. Venneman, Robert C. Verdonk, Joost P.H. Drenth, Thomas R. de Wijkerslooth, Erwin J.M. van Geenen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

5 Citations (Scopus)
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Abstract

Background: Acute cholangitis is an infection requiring endoscopic retrograde cholangiopancreatography (ERCP) and antibiotics. Several diagnostic tools help to diagnose cholangitis. Because diagnostic performance of these tools has not been studied and might therefore impose unnecessary ERCPs, we aimed to evaluate this. Methods: We established a nationwide prospective cohort of patients with suspected biliary obstruction who underwent an ERCP. We assessed the diagnostic performance of Tokyo Guidelines (TG18), Dutch Pancreatitis Study Group (DPSG) criteria, and Charcot triad relative to real-world cholangitis as the reference standard. Results: 127 (16%) of 794 patients were diagnosed with real-world cholangitis. Using the TG18, DPSG, and Charcot triad, 345 (44%), 55 (7%), and 66 (8%) patients were defined as having cholangitis, respectively. Sensitivity for TG18 was 82% (95% CI 74-88) and specificity 60% (95% CI 56-63). The sensitivity for DPSG and Charcot was 42% (95% CI 33-51) and 46% (95% CI 38-56), specificity was 99.7% (95% CI 99-100) and 99% (95% CI 98-100), respectively. Conclusions: TG18 criteria incorrectly diagnoses four out of ten patients with real-world cholangitis, while DPSG and Charcot criteria failed to diagnose more than half of patients. As the cholangitis diagnosis has many consequences for treatment, there is a need for more accurate diagnostic tools or work-up towards ERCP.

Original languageEnglish
Pages (from-to)479-486
Number of pages8
JournalJournal of Hepato-Biliary-Pancreatic Sciences
Volume29
Issue number4
Early online date8 Dec 2021
DOIs
Publication statusPublished - Apr 2022

Bibliographical note

Funding Information:
The study was funded by the Netherlands Organisation for Health Research and Development (ZonMw; grant number 837001506) and the Radboud university medical center. The funding source has no role in the design, practice or analysis of this study.

Publisher Copyright:
© 2021 The Authors. Journal of Hepato-Biliary-Pancreatic Sciences published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Hepato-Biliary-Pancreatic Surgery.

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