We read the article by Ovalle et al. (2023), which presents a retrospective methodological model and evaluates the efficacy of the predictive criteria of the American Society for Gastrointestinal Endoscopy (ASGE), in the diagnosis of choledocholithiasis at secondary care public hospitals in Mexico.1

Ovalle et al. (2023) selected a population sample of individuals of any age that had a history or clinical symptomatology of choledocholithiasis.1 On the other hand, studies conducted by Gastelbondo et al. (2020) and Muñoz et al. (2021) included a population sample made up exclusively of individuals over 18 years of age that had clinical or laboratory suspicion of the disease, given that such a sample better defined the group to be studied, enabling more accurate results to be obtained.2,3

In addition, in their research article, Ovalle et al. (2023) did not take certain important points regarding the exclusion of patients into account.1 In contrast, as exclusion criteria, Lourido et al. (2022) included patients whose clinical histories were deficiently written and patients that had an inconclusive diagnosis of choledocholithiasis.4

On the other hand, Ovalle et al. (2023) showed that the risk predictors were specifically divided into high, intermediate, and low risk, each with its clinical points.1 Machaín et al. (2021) reported the same, but also described altered liver enzymes and acute biliary pancreatitis as clinical processes of moderate or intermediate predictors of choledocholithiasis, a proposal that is supported by the ASGE.5

In conclusion, we wish to thank the researchers for their fine work, enabling us to have a deeper understanding of choledocholithiasis and the criteria currently proposed by the ASGE, which are essential for managing and predicting the disease.