ASGE 2019 versus ESGE 2019 criteria for predicting choledocholithiasis: a systematic review and meta-analysis of head-to-head diagnostic accuracy studies

In adults with suspected choledocholithiasis, what are the sensitivity and specificity of high-risk classification by the 2019 ASGE criteria compared with the 2019 ESGE criteria, when both are applied to the same patients, and what are the resulting consequences for ERCP use and demand for MRCP/EUS? This systematic review and meta-analysis synthesises head-to-head diagnostic accuracy studies to directly compare the two criteria and quantify their comparative performance and resource implications, informing guideline selection across different healthcare contexts, including resource-limited settings. This is a retrospective registration: the literature search, study selection, data extraction, risk-of-bias assessment and meta-analysis were already complete and the manuscript already drafted at the time of this registration, which is being completed at the explicit invitation of a Surgical Endoscopy peer reviewer.