0000005752 00000 n World J Gastroenterol. Core clinical questions were derived using an iterative process by the ASGE SOP Committee. Clin Endosc. Choledocholithiasis, ERCP, Common bile duct exploration, Management, Diagnosis. 3300 Woodcreek Dr., Downers Grove, IL 60515 Systematic review and meta-analysis of the 2010 ASGE non-invasive predictors of choledocholithiasis and comparison to the 2019 ASGE predictors. Although studies show EDGE to be safe and effective, there are concerns regarding persistent gastrogastric fistula and weight gain following stent removal in which it is recommended that either an upper endoscopy or upper GI series be obtained in all patients post-stent removal to determine the presence of persistent fistula. The energy setting and number of discharges delivered is dependent on the device used and patient tolerance as the main adverse effects include pain, local hematoma formation, cardiac arrhythmias, biliary obstruction, hemobilia and hematuria [31]. Quality documents define the indicators of high-quality endoscopy and how to measure it. 2023 Society of American Gastrointestinal and Endoscopic Surgeons. Other diagnostic modalities to detect common bile duct stones include endoscopic ultrasound (EUS) in which an echo endoscope is positioned in the duodenal bulb in which the average sensitivity and specificity is approximately 95 and 97%, respectively [5]. 0000007642 00000 n If you have any questions or suggestions, please contact Customer Support at Info@asge.org. ASGE high likelihood criteria had sensitivity and specificity Following biliary clearance with ERCP, it is generally recommended to proceed with subsequent cholecystectomy to prevent the occurrence of recurrent episodes of symptomatic cholelithiasis which occurs in approximately 20% of patients. This content is available to ASGE Members only. Ultrasound findings consistent with choledocholithiasis include visualization of a common bile duct stone and a dilated common bile duct greater than 8-mm [3]. To note, papillary balloon dilation, as an alternative to sphincterotomy, appears to be a feasible strategy for removal of choledocholithiasis during endoscopic retrograde cholangiopancreatography (ERCP) sphincterotomy [1]. Articles pertaining to management strategies for choledocholithiasis and best clinical scenarios for the application of each strategy are summarized below under each question. Patients with AGP may also present with choledocholithiasis. Image permissions obtained from Cook Medical and Boston Scientific. Chvez Rossell MA. However, the timely availability of alternative imaging and patient morbidity may drive diagnostic and therapeutic pathways in individual patients and environments. ASGE high-risk criteria for choledocholithiasis - PubMed 2demonstrates the recommended approach to choledocholithiasis dependent on whether it is discovered pre-operatively, intraoperatively or post-operatively. Guidelines are not a substitute for physicians opinion on individual patients. Following this, immediate antimicrobial therapy targeted to the biliary tract and biliary drainage are the key goals of the treatment of acute cholangitis [38]. The common bile duct can then be accessed with a small-bore catheter for saline flushes, which may be successful in dislodging stones into the duodenum. 2017 Sep;86(3):525-532. doi: 10.1016/j.gie.2017.01.039. Unable to load your collection due to an error, Unable to load your delegates due to an error. At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made. Cochrane Database Syst Rev 2:CD011548, Barkun AN, Barkun JS, Fried GM, Ghitulescu G, Steinmetz O, Pham C, Meakins JL, Goresky CA (1994) Useful predictors of bile duct stones in patients undergoing laparoscopic cholecystectomy: McGill Gallstone Treatment Group. If you have any questions or suggestions, please contact Customer Support at Info@asge.org. ERCP is highly sensitive and specific for choledocholithiasis with the added benefit of being therapeutic to clear stones from the biliary tree in an attempt to avoid common bile duct exploration and prevent distal obstruction. It is very important that you consult your doctor about your specific condition. The https:// ensures that you are connecting to the If the patient is found to have choledocholithiasis intraoperatively and the biliary tree cannot be successfully cannulated for stone extraction, a post-operative ERCP, further surgical attempts via laparoscopic or open techniques or percutaneous biliary drainage can be pursued depending on local expertise and resource availability (Fig. ASGE strives to provide clinically relevant and practical recommendations, which can help standardize patient care and improve outcomes. Of these 25 patients, 9 patients had choledocholithiasis, 9 patients had sludge and 7 patients had a normal ERCP. Common bile duct exploration was traditionally performed as an open procedure but can be performed laparoscopically either via a transcystic approach or transductal approach. Los Angeles, CA 90064 USA choledocholithiasis ranges from 5% to 10% in those patients startxref Bookshelf Clipboard, Search History, and several other advanced features are temporarily unavailable. 2.Clinical ascending cholangitis? ASGE evidence-based guidelines provide clinicians with recommendations for the evaluation, diagnosis, and management of patients undergoing endoscopic procedures of the digestive tract. Rent Institute for Training and Technology, ASGE guideline on post-ERCP pancreatitis prevention strategies: summary and recommendations, https://doi.org/10.1016/j.gie.2022.10.005, ASGE guideline on post-ERCP pancreatitis prevention strategies: methodology and review of evidence, https://doi.org/10.1016/j.gie.2022.09.011, Adverse events associated with EGD and EGD-related techniques, https://doi.org/10.1016/j.gie.2022.04.024, ASGE guideline on informed consent for GI endoscopic procedures, https://www.giejournal.org/article/S0016-5107(21)01759-4/fulltext, ASGE guideline on screening for pancreatic cancer in individuals with genetic susceptibility: summary and recommendations, https://doi.org/10.1016/j.gie.2021.12.001, ASGE guideline on screening for pancreatic cancer in individuals with genetic susceptibility: methodology and review of evidence, https://doi.org/10.1016/j.gie.2021.12.002, Adverse events associated with EUS and EUS-guided procedures, https://doi.org/10.1016/j.gie.2021.09.009, ASGE guideline on the management of cholangitis, https://doi.org/10.1016/j.gie.2020.12.032, ASGE guideline on the role of endoscopy in the management of malignant hilar obstruction, https://doi.org/10.1016/j.gie.2020.12.035, ASGE Guideline on the Role of Endoscopy in the Management of Benign and Malignant Gastroduodenal Obstruction, https://doi.org/10.1016/j.gie.2020.07.063, American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in familial adenomatous polyposis syndromes, https://doi.org/10.1016/j.gie.2020.01.028, ASGE guideline on minimum staffing requirements for the performance of GI endoscopy, https://doi.org/10.1016/j.gie.2019.12.002, Endoscopic Recognition and Management Strategies for Malignant Colorectal Polyps Recommendations of the US MultiSociety Task Force, https://doi.org/10.1016/j.gie.2020.09.039, Endoscopic Removal of Colorectal LesionsRecommendations by the US Multi-Society Task Force on Colorectal Cancer, https://doi.org/10.1016/j.gie.2020.01.029, Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer, https://doi.org/10.1016/j.gie.2020.01.014, American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the management of acute colonic pseudo-obstruction and colonic volvulus, https://doi.org/10.1016/j.gie.2019.09.007, ASGE guideline on the management of achalasia, https://doi.org/10.1016/j.gie.2019.04.231, ASGE guideline on screening and surveillance of Barretts esophagus, https://doi.org/10.1016/j.gie.2019.05.012, ASGE guideline on the role of endoscopy for bleeding from chronic radiation proctopathy, https://doi.org/10.1016/j.gie.2019.04.234, ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis, https://doi.org/10.1016/j.gie.2018.10.001, The role of endoscopy in the management of choledocholithiasis, Endoscopic eradication therapy for patients with Barretts esophagusassociated dysplasia and intramucosal cancer, https://doi.org/10.1016/j.gie.2017.10.011, http://dx.doi.org/10.1016/j.gie.2015.04.003, The role of endoscopy in the management of premalignant and malignant conditions of the stomach, http://dx.doi.org/10.1016/j.gie.2015.03.1967, The role of endoscopy in the management of GERD, http://dx.doi.org/10.1016/j.gie.2015.02.021, The role of endoscopy in the bariatric surgery patient, http://dx.doi.org/10.1016/j.gie.2014.09.044, The role of endoscopy in the evaluation and management of dysphagia, http://dx.doi.org/10.1016/j.gie.2013.07.042, The role of endoscopy in the assessment and treatment of esophageal cancer, http://dx.doi.org/10.1016/j.gie.2012.10.001, Management of ingested foreign bodies and food impactions, http://dx.doi.org/10.1016/j.gie.2010.11.010, Colorectal cancer screening: Recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer, http://dx.doi.org/10.1016/j.gie.2017.04.003, Recommendations on fecal immunochemical testing to screen for colorectal neoplasia: a consensus statement by the US Multi-Society Task Force on colorectal cancer, http://dx.doi.org/10.1016/j.gie.2016.09.025, The role of endoscopy in the management of suspected small-bowel bleeding, http://dx.doi.org/10.1016/j.gie.2016.06.013, Colonoscopy surveillance after colorectal cancer resection: recommendations of the US multi-society task force on colorectal cancer, http://dx.doi.org/10.1016/j.gie.2016.01.020, The role of endoscopy in inflammatory bowel disease, http://dx.doi.org/10.1016/j.gie.2014.10.030, SCENIC international consensus statement on surveillance and management of dysplasia in inflammatory bowel disease, http://dx.doi.org/10.1016/j.gie.2014.12.009, The role of deep enteroscopy in the management of small-bowel disorders, http://dx.doi.org/10.1016/j.gie.2015.06.046, The role of endoscopy in the management of constipation, http://dx.doi.org/10.1016/j.gie.2014.06.018, The role of endoscopy in the patient with lower GI bleeding, http://dx.doi.org/10.1016/j.gie.2013.10.039, The role of endoscopy in the management of patients with diarrhea, http://dx.doi.org/10.1016/j.gie.2009.11.025, The role of endoscopy in the staging and management of colorectal cancer, http://dx.doi.org/10.1016/j.gie.2013.04.163, Guidelines for colonoscopy surveillance after screening and polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer, http://dx.doi.org/10.1053/j.gastro.2012.06.001, The role of endoscopy in patients with anorectal disorders, http://dx.doi.org/10.1016/j.gie.2010.04.022, The role of endoscopy in the diagnosis and treatment of cystic pancreatic neoplasms, http://dx.doi.org/10.1016/j.gie.2016.04.014, The role of endoscopy in the diagnosis and treatment of inflammatory pancreatic fluid collections, http://dx.doi.org/10.1016/j.gie.2015.11.027, The role of endoscopy in the evaluation and management of patients with solid pancreatic neoplasia, http://dx.doi.org/10.1016/j.gie.2015.09.009, The role of endoscopy for benign pancreatic disease, http://dx.doi.org/10.1016/j.gie.2015.04.022, The role of ERCP in benign diseases of the biliary tract, http://dx.doi.org/10.1016/j.gie.2014.11.019, The role of endoscopy in the evaluation and treatment of patients with biliary neoplasia, http://dx.doi.org/10.1016/j.gie.2012.09.029, Role of EUS for the evaluation of mediastinal adenopathy, http://dx.doi.org/10.1016/j.gie.2011.03.1255, http://dx.doi.org/10.1016/j.gie.2016.06.051, http://dx.doi.org/10.1016/j.gie.2012.03.252, Guidelines for privileging, credentialing, and proctoring to perform GI endoscopy, http://dx.doi.org/10.1016/j.gie.2016.10.036, ASGE Position Statement: endoscopic bariatric therapies in clinical practice, http://dx.doi.org/10.1016/j.gie.2015.06.038, ASGE guideline for infection control during GI endoscopy, https://doi.org/10.1016/j.gie.2017.12.009, Race and ethnicity considerations in GI endoscopy, http://dx.doi.org/10.1016/j.gie.2015.06.002, http://dx.doi.org/10.1016/j.gie.2015.03.1917, The role of industry representatives in the endoscopy unit, Guidelines for safety in the gastrointestinal endoscopy unit, http://dx.doi.org/10.1016/j.gie.2013.12.015, http://dx.doi.org/10.1016/j.gie.2012.01.011, Guidelines for sedation and anesthesia in GI endoscopy, http://dx.doi.org/10.1016/j.gie.2017.07.018, Management of antithrombotic agents for patients undergoing GI endoscopy, http://dx.doi.org/10.1016/j.gie.2015.09.035, http://dx.doi.org/10.1016/j.gie.2014.09.048, http://dx.doi.org/10.1016/j.gie.2014.08.008, Optimizing adequacy of bowel cleansing for colonoscopy: Recommendations from the U.S. Multi-Society Task Force on Colorectal Cancer, http://dx.doi.org/10.1016/j.gie.2014.08.002, Routine laboratory testing before endoscopic procedures, http://dx.doi.org/10.1016/j.gie.2014.01.019, The role of endoscopy in subepithelial lesions of the GI tract, http://dx.doi.org/10.1016/j.gie.2017.02.022, http://dx.doi.org/10.1016/j.gie.2010.10.021, The role of endoscopy in ampullary and duodenal adenomas, http://dx.doi.org/10.1016/j.gie.2015.06.027, The role of endoscopy in the management of patients with peptic ulcer disease, http://dx.doi.org/10.1016/j.gie.2009.11.026, Modifications in endoscopic practice for pediatric patients, http://dx.doi.org/10.1016/j.gie.2013.08.014, http://dx.doi.org/10.1016/j.gie.2013.04.167, Guia - Endoscopia en Mujeres Embarazadas y Lactantes, http://dx.doi.org/10.1016/j.gie.2012.02.029, Profilaxis antibitica para endoscopa gastrointestinal, Optimizacion de la adecuacion de la limpieza intestinal para la colonoscopia, El manejo de agentes antitromboticos para pacientes sometidos a endoscopia gastro intestinal (GI), Quality indicators for capsule endoscopy and deep enteroscopy, https://doi.org/10.1016/j.gie.2022.08.039, GI Endoscope Reprocessing: A Comparative Review of Organizational Guidelines and Guide for 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World J Gastroenterol 21:820828, Chung SC, Leung JW, Leong HT, Li AK (1991) Mechanical lithotripsy of large common bile duct stones using a basket. Dynamic liver test patterns do not predict bile duct stones. 1may be helpful for managing patients with suspected choledocholithiasis dependent on their risk stratification. If this is not successful, stones can be extracted with a wire basket or Fogarty balloons under fluoroscopic guidance. Guidelines are intended to be flexible. The American Society for Gastrointestinal Endoscopy (ASGE) revised its guidelines for risk stratification of patients with suspected choledocholithiasis. If the stones cannot be extracted concurrently with biliary drainage in these critically ill patients, two-session treatment can be pursued with endoscopic biliary stenting performed as initial treatment followed by endoscopic stone removal after improvement of cholangitis [39]. Conclusion: 2023 May;68(5):2061-2068. doi: 10.1007/s10620-022-07773-5. Endoscopy. Accuracy of SAGES, ASGE, and ESGE criteria in predicting choledocholithiasis. Technology evaluations provide a review of existing, new, or emerging endoscopic technologies that have an impact on the practice of GI endoscopy. Traditionally, patients with CBD stones that were unable to be extracted endoscopically would have to undergo common bile duct exploration. Wang L, Mirzaie S, Dunnsiri T, Chen F, Wilhalme H, MacQueen IT, Cryer H, Eastoak-Siletz A, Guan M, Cuff C, Tabibian JH. See this image and copyright information in PMC. Dig Dis 26:324329, Kedia P, Tyberg A, Kumta NA, Gaidhane M, Karia K, Sharaiha RZ, Kahaleh M (2015) EUS-directed transgastric ERCP for Roux-en-Y gastric bypass anatomy: a minimally invasive approach. A systematic English literature search was conducted in PubMed to determine the appropriate management strategies for choledocholithiasis.The following clinical spotlight review is meant to critically review the available evidence and provide recommendations for the work-up, investigations as well as the endoscopic, surgical and percutaneous techniques in the management of choledocholithiasis. Bethesda, MD 20894, Web Policies Moon JH, Cho YD, Cha SW, Cheon YK, Ahn HC, Kim YS, Kim YS, Lee JS, Lee MS, Lee HK, Shim CS, Kim BS. (2020)Retrospective comparative analysis of choledochoscopic bile duct exploration versus ERCP for bile duct stones. See this image and copyright information in PMC. Gastrointest Endosc 71:1-9, Khan MA, Khan Z, Tombazzi CR, Gadiparthi C, Lee W, Wilcox CM (2018) Role of cholecystectomy after endoscopic sphincterotomy in the management of choledocholithiasis in high-risk patients: a systematic review and meta-analysis. The working group first determined questions relevant to the clinical practice of surgeons treating patients with choledocholithiasis. Gastrointest Endosc. 0000005448 00000 n Jang SI, Kim DU, Cho JH, et al. A transductal approach can be attempted laparoscopically if the surgeon has the needed expertise and if the common bile duct is at least 7mm in diameter to reduce the risk of post-operative stricture. Aims To evaluate the utility of the main international guidelines and proposed algorithms for the prediction of concurrent choledocholithiasis in patients with acute cholecystitis. Whenever possible, guidelines are based on the GRADE(Grading of Recommendation Assessment, Development and Evaluation) methodology. 0000006619 00000 n eCollection 2023 Apr. 0000006068 00000 n The success rate of stone clearance via a transcystic approach can reach up to 71% [23]. Br J Surg 84:14071409, DiSario J, Ram C, Croffie J, Liu J, Mishkin D, Shah R, Somogyi L, Tierney W, Song LM, Petersen BT (2007) Biliary and pancreatic lithotripsy devices. Methods An observational retrospective study including hospitalized patients admitted with acute cholecystitis between January 2016 and December 2020 at Edit Wolfson Medical Center. . The detection of bile duct stones in suspected biliary pancreatitis: comparison of MRCP, ERCP, and intraductal US. All recommendations follow a rigorous process based on a systematic review of medical literature as outlined by the National Academy of Medicine (formerly Institute of Medicine) standards for guideline development. 0000002496 00000 n If these methods continue to be unsuccessful and the stone is unable to be retrieved, the short-term use of a temporary biliary stent either placed endoscopically, intraoperatively or percutaneously via interventional radiology can be used to ensure adequate biliary drainage followed by further attempts at ERCP or surgery. (2020)Comparison of the Relative Safety and Efficacy of Laparoscopic Choledochotomy with Primary Closure and Endoscopic Treatment for Bile Duct Stones in Patients with Cholelithiasis. Privacy Policy | Terms of Use ASGE classified 17 (7.4 %) additional patients as high likelihood compared with ESGE, only one of whom had choledocholithiasis. A novel non-slip banded balloon catheter for endoscopic sphincteroplasty: an ex vivo and in vivo pilot study. 52(9):736-744. Guidelines are not a substitute for physicians opinion on individual patients. We also found that while the 2010 ASGE guidelines in predicting high risk for choledocholithiasis had a specificity of 75.8%, using the 2019 ASGE guidelines led to an improved specificity of 89.4%. DOCX f6publishing.blob.core.windows.net 0000007249 00000 n Other strong predictors for choledocholithiasis include clinical evidence of acute cholangitis, a bilirubin greater than 1.7mg/dL and a dilated CBD; the presence of two or more of these factors has a pre-test probability of 50%-94% for choledocholithiasis (considered high) [7,8]. If the diagnosis of choledocholithiasis is still in question following these tests, magnetic resonance cholangiopancreatography (MRCP) is a non-invasive option, which has a sensitivity of>90% and specificity nearing 100% [4]. Web Design and Development by Matrix Group International, Inc. Clipboard, Search History, and several other advanced features are temporarily unavailable. (2020)Multicenter randomized trial of endoscopic papillary large balloon dilation without sphincterotomy versus endoscopic sphincterotomy for removal of bile duct stones: MARVELOUS trial. ASGE guideline on screening and surveillance of Barrett's esophagus. Evaluating the accuracy of American Society for Gastrointestinal The https:// ensures that you are connecting to the 3). All Rights Reserved. Half the patients were at least 65 years old. Results: Of 2724 patients with suspected choledocholithiasis, 1171 (43%) met high-risk criteria. Gastroenterology 96:146152, Johnson GK, Geenen JE, Venu RP, Schmalz MJ, Hogan WJ (1993) Treatment of non-extractable common bile duct stones with combination ursodeoxycholic acid plus endoprostheses. Choledocholithiasis is a common presentation of symptomatic cholelithiasis that can result in biliary obstruction, cholangitis, and pancreatitis. Low Detection Rates of Bile Duct Stones During Endoscopic Treatment for Highly Suspected Bile Duct Stones with No Imaging Evidence of Stones. Epub 2021 Mar 22. Comprehensive systematic reviews were also performed to assess the following: same-admission cholecystectomy for gallstone pancreatitis, clinical predictors of choledocholithiasis, optimal timing of ERCP vis--vis cholecystectomy, management of Mirizzi syndrome and hepatolithiasis, and biliary stent therapy for choledocholithiasis. Panel members provide ongoing conflict of interest (COI) disclosures, including intellectual conflicts of interest, throughout the development and publication of all guidelines in accordance with the ASGE Policy for Managing Declared Conflicts of Interests. Endoscopy (ASGE). 0000034920 00000 n Surg Endosc. Additional data on the long term outcomes of this procedure (i.e., how many patients develop gastrogastric fistulae?) %PDF-1.4 % A systematic English literature search was conducted in PubMed to determine the appropriate management strategies for choledocholithiasis.The following clinical spotlight review is meant to critically review the available evidence and provide . Results: The guidelines by the American Society for Gastrointestinal Endoscopy (ASGE) suggest that in patients with gallbladder in situ, endoscopic retrograde cholangiopancreatography (ERCP) should be performed in the presence of high-risk criteria for choledocholithiasis, after biochemical tests and abdominal ultrasound. 0000102312 00000 n Using ASGE guidelines, 230 (22.1 %), 678 (65.1 %), and 134 (12.9 %) met high, intermediate, and low likelihood criteria, respectively. In balloon-assisted ERCP, the enteroscope has a working length of 200cm and the 12-mm diameter Overtube has a length of 140cm. Careers. If a T-tube is used, the T-tube is left to gravity drainage post-operatively for 1week and imaged with T-tube cholangiography prior to consideration of removal. 0000045574 00000 n Definitive . Patients without evidence of jaundice and a normal bile duct on ultrasound have a low probability of choledocholithiasis (<5%) [9]. -, ASGE Standards of Practice Committee. Current practice guidelines for suspected choledocholithiasis: new Here you will find ASGE guidelines for standards of practice. ASGE Standards of Practice Committee, James L. Buxbaum, MD, FASGE, Syed M. Abbas Fehmi, MD, MSc, FASGE, Shahnaz Sultan, MD, MHSc, Douglas S. Fishman, MD, FAAP, FASGE, Bashar J. Qumseya, MD, MPH, Victoria K. Cortessis, PhD, Hannah Schilperoort, MLIS, MA, Lynn Kysh, MLIS, Lea Matsuoka, MD, FACS, Patrick Yachimski, MD, MPH, FASGE, AGAF, Deepak Agrawal, MD, MPH, MBA, Suryakanth R. Gurudu, MD, FASGE, Laith H. Jamil, MD, FASGE, Terry L. Jue, MD, FASGE, Mouen A. Khashab, MD, Joanna K. Law, MD, Jeffrey K. Lee, MD, MAS, Mariam Naveed, MD, Mandeep S. Sawhney, MD, MS, FASGE, Nirav Thosani, MD, Julie Yang, MD, FASGE, Sachin B. Wani, MD, FASGE (ASGE Standards of Practice Committee Chair), Rent Institute for Training and Technology, ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis, https://doi.org/10.1016/j.gie.2018.10.001, Gastrointest Endosc June 2019, Volume 89, Issue 6, Pages 10751105.e15, /docs/default-source/guidelines/asge-guideline-on-the-role-of-endoscopy-in-the-evaluation-and-management-of-choledocholithiasis-2019-june-gie.pdf?Status=Master&sfvrsn=2, ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis 2019 June GIE.
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