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Introduction

Predicting choledocholithiasis in acute pancreatitis is challenging. Existing predictive models typically rely on the common bile duct (CBD) width, a parameter difficult to assess reliably. We aimed to develop a model based solely on easily available clinical and laboratory markers, excluding CBD width.

Aims & Methods

We conducted a retrospective cohort study of 348 patients treated for acute pancreatitis at the LMU University Hospital in Munich, Germany, between 2005 and 2021. A Random Forrest (RF) model was developed using the TensorFlow Decision Forests (TFDF) library with 14 clinical and laboratory features, excluding CBD width. Model performance was assessed using sensitivity, specificity, predictive values, and area under the receiver operating characteristic curve (AUC-ROC).

Results

Of 348 patients with acute biliary pancreatitis, 167 (48.0%) had CBD stones. Our model achieved a sensitivity of 92.3%, a negative predictive value (NPV) of 83.3%, and an AUC-ROC of 0.739. Compared to using CBD width ≥8 mm or bilirubin ≥4 mg/dl as predictors (as guidelines recommend), our model demonstrated superior sensitivity (92.3% vs. 79.5% vs. 30.8%, respectively) and NPV (83.3% vs. 74.3% vs. 54.8%, respectively). The rate of missed intraductal concrements was substantially lower with our model (4.3% vs. 41.4%). In subgroup analysis, our model performed better in predicting stones (AUC=0.8) than microlithiasis or sludge (AUC=0.623).

Conclusion

We developed the first machine learning-based score to predict choledocholithiasis in acute pancreatitis without relying on CBD width. The model's high sensitivity and NPV make it a promising tool for clinical decision-making, specifically for hospitals without the option of endosonography.

Disclosure

SS is funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) - 413635475 - and the LMU Munich Clinician Scientist Program (MCSP).

PREDICTING CHOLEDOCHOLITHIASIS IN ACUTE BILIARY PANCREATITIS – A NEW SCORE INDEPENDENT OF IMAGING AND COMMON BILE DUCT WIDTH

Arlett Patricia Gloria Schäfer 1, Simon Sirtl 1, Katharina Bretthauer 1, Eric Hohmann 1, Mali Junge 1, Mahmood Ahmad 1, Jakob Vielhauer 1, Anna Hausdorf 1, Max Ole Hubert 1, Raul Velamazan Sandalinas 2, Ughur Aghamaliyev 3, Jörg Schirra 1, Christian Schulz 1, Michal Zorniak 4, Georg Beyer 1, Ujjwal Mahajan 1, Julia Mayerle 1, Hans Stubbe 1

1 LMU University Hospital Munich, Munich, Germany

2 Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain

3 LMU University Hospital, Munich, Germany

4 The Maria Sklodowska-Curie National Research Institute of Oncology (MSCNRIO), Gliwice, Poland

Conference

UEG Week Berlin 2025

Topics

Pancreas

Submission format

Abstract

Session

Acute pancreatitis: Complications and consequences (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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Early versus delayed endoscopic necrosectomy (Complete Session)

Event

UEG Week Berlin 2025

Topics

Endoscopy

Session

Early versus delayed endoscopic necrosectomy

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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Dilated main pancreatic duct of unknown origin: Chronic pancreatitis or MD-IPMN?

Alexander Arlt 1

1 Klinikum Oldenburg, Oldenburg, Germany

Event

UEG Postgraduate Teaching Programme Berlin 2025

Topics

Endoscopy Histopathology Pancreas

Session

Cystic pancreatic lesions

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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Persistent lipase and localised damage: Cause or consequence?

Peter Hegyi 1

1 University of Pecs, Pecs, Hungary

Event

UEG Week Berlin 2025

Topics

Endoscopy Pancreas

Session

Therapy update: Acute severe pancreatitis – It's all about timing!

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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BILE LIQUID BIOPSY IN PANCREATOBILIARY TUMORS: A NOVEL APPROACH TO DETECT ACTIONABLE MUTATIONS

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Introduction

Biliary strictures are usually caused by malignancies such as Cholangiocarcinoma (CCA) or Pancreatic Ductal Adenocarcinoma (PDAC). 70% of these neoplasms are diagnosed at advanced stages due to late-onset symptoms, lack of biomarkers, and challenges in obtaining histological samples. Curative surgical resection with adjuvant therapy is the first-line treatment, but 20% of cases are resectable at diagnosis and 80% relapse within 3 years^1,2. The impact of systemic therapies on overall survival remains limited, however new targeted therapies have shown remarkable efficacy in patients with actionable mutations based on tumor genetic profiling. Clinical guidelines advocate multigene panel analysis of tumor tissue prior to or during first-line treatment^3,4, considering that 40% of CCA patients and around 25% of PDAC patients harbor actionable genetic mutations^5,6. When tumor tissue is insufficient, liquid biopsies using cfDNA can be considered³. Liquid biopsy of bile, collected during an Endoscopic Retrograde Cholangiopancreatography (ERCP) in malignant biliary stricture cases, could potentially detect therapeutic targets.

Aims & Methods

This prospective proof-of-concept pilot study aims to assess NGS-based cfDNA analysis in bile as a novel liquid biopsy for detecting genetic mutations, and specifically actionable mutations, compared to tissue NGS.
19 CCA and 9 PDAC patients with malignant biliary stenosis undergoing ERCP in a tertiary hospital (2017-2020) were included. Bile samples were collected during the first ERCP and the Pathological Anatomy department selected tissue samples with ≥40% tumor content. Massive sequencing of DNA libraries was performed using the Pan-Cancer Panel^TM (52-genes) for bile samples, and the Oncomine^TM Comprehensive Assay Panel v3 (161 genes) for tissue.

Results

Concerning CCA patients, bile NGS identified all patients with mutations (19/19) opposite to 84.3% (16/19) of patients in tissue. Bile NGS identified 7 patients (37%) with actionable mutations, none was detected in tissue. We detected 47/49 mutations in bile NGS vs. 22/49 in tissue. High concordance was observed: 91% (20/22) of tissue mutations were also in bile. Regarding actionable mutations considered in ESMO guidelines³; 7 were detected in bile NGS, none detected in tissue. The actionable mutations identified were ERBB2 (5), IDH2 (1), and KRAS^G12C(1).
In the PDAC group, bile NGS identified 89% (8/9) of patients with mutations, compared to 66.6% (6/9) of patients in tissue. Bile NGS identified 5 patients (55%) with actionable mutations vs. 4 (44%) in tissue. Bile NGS detected 16/18 mutations in bile in contrast to 12/18 in tissue. High concordance was observed: 83.3% (10/12) of tissue mutations were also in bile. NGS in bile detected 6 actionable mutations considered in ESMO guidelines^4,; KRAS^G12D (5) and ERBB3, compared to 4 in tissue; KRAS^G12D.

Conclusion

These results highlight the potential of bile liquid biopsy in detecting actionable mutations; bile NGS increased the diagnosis sensibility and the number of mutations detected, compared with tissue NGS, which could allow more patients to be considered for targeted therapies. This approach does not require histological material consumption and collecting bile during an ERCP is simple and secure. In addition, NGS technology is available in all molecular laboratories. We consider that the application of liquid biopsy in bile can be accessible and an effective tool, with direct and immediate clinical implementation, improving precision medicine strategies and the therapeutic management of CCA and PDAC patients with biliary stenosis.

References

1. Banales JM, Marin JJG, Lamarca A, Rodrigues PM, Khan SA, Roberts LR, et al. Cholangiocarcinoma 2020: the next horizon in mechanisms and management. Nat Rev Gastroenterol Hepatol. 2020 Sep;17(9):557-588. Epub 2020 Jun 30.
2.Park W, Chawla A, O’Reilly EM. Pancreatic Cancer: A Review. JAMA. 2021 Sep 7;326(9):851–62.3.
3.Vogel A, Ducreux M; ESMO Guidelines Committee. ESMO Clinical Practice Guideline interim update on the management of biliary tract cancer. ESMO Open. 2025 Jan;10(1):104003. Epub 2024 Dec 17.
4.Conroy T, Pfeiffer P, Vilgrain V, Lamarca A, Seufferlein T, O’Reilly EM, et al. Pancreatic cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2023 Nov;34(11):987–1002.
5. Gilbert TM, Randle L, Quinn M, McGreevy O, O'leary L, Young R, et al. Molecular biology of cholangiocarcinoma and its implications for targeted therapy in patient management. Eur J Surg Oncol. 2025 Feb;51(2):108352. Epub 2024 Apr 17
6. Boileve A, Smolenschi C, Lambert A, Boige V, Tarabay A, Valery M, et al. Role of molecular biology in the management of pancreatic cancer. World J Gastrointest Oncol. 2024 Jul 15;16(7):2902-2914.