Sex-related differences in predicting choledocholithiasis using current American Society of Gastrointestinal Endoscopy risk criteria

BACKGROUND: American Society of Gastrointestinal Endoscopy (ASGE) criteria is widely used to predict probability of choledocholithiasis among patients with symptomatic gallstone disease but does not take sex into consideration. METHODS: The cohort study included patients who underwent either endoscopic retrograde cholangiopancreatography or intraoperative cholangiography for suspected choledocholithiasis at our medical center. Clinical, laboratory and radiological data were collected for each patient and used to stratify them based on the ASGE risk criteria for choledocholithiasis. RESULTS: A total of 646 patients composed the final study cohort. The composite incidence rate of choledocholithiasis for male and female groups was 47.5% and 46.2% respectively. Total bilirubin (>4 mg/dL), cholangitis, abnormal liver function tests (transaminitis), dilation of the common bile duct (>6 mm) on ultrasound examination, and biliary pancreatitis were individually associated with choledocholithiasis in 73.5%, 68.4%, 61.1%, 60.0%, and 51.7% of males, respectively. Total bilirubin >4 mg/dL and 1.8-4 mg/dL, cholangitis, and transaminitis were individually associated with choledocholithiasis in 82.6%, 64.0%, 58.2%, and 50.0% of females, respectively. The distribution in probability group/incidence of choledocholithiasis was as follows: for males, low probability 3.3%/0%, intermediate probability 56.7%/33.8%), high probability 40%/77.8%; and for females, low probability 5.3%/14.3%, intermediate probability 70.2%/39.6%, high probability 24.5%/72.1%. CONCLUSIONS: The composite incidence for choledocholithiasis was similar across male and female patients. A significantly higher proportion of females compared to males were in the intermediate probability group. Better sex stratification can help improve the positive and negative predictive values of ASGE risk stratification criteria. Improve patient outcomes and reduce associated healthcare cost.