ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis

ASGE Standards of Practice Committee; James L Buxbaum; Syed M Abbas Fehmi; Shahnaz Sultan; Douglas S Fishman; Bashar J Qumseya; Victoria K Cortessis; Hannah Schilperoort; Lynn Kysh; Lea Matsuoka; Patrick Yachimski; Deepak Agrawal; Suryakanth R Gurudu; Laith H Jamil; Terry L Jue; Mouen A Khashab; Joanna K Law; Jeffrey K Lee; Mariam Naveed; Mandeep S Sawhney; Nirav Thosani; Julie Yang; Sachin B Wani

doi:10.1016/j.gie.2018.10.001

ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis

Gastrointest Endosc. 2019 Jun;89(6):1075-1105.e15. doi: 10.1016/j.gie.2018.10.001. Epub 2019 Apr 9.

Authors

ASGE Standards of Practice Committee; James L Buxbaum¹, Syed M Abbas Fehmi², Shahnaz Sultan³, Douglas S Fishman⁴, Bashar J Qumseya⁵, Victoria K Cortessis¹, Hannah Schilperoort⁶, Lynn Kysh⁶, Lea Matsuoka⁷, Patrick Yachimski⁸, Deepak Agrawal⁹, Suryakanth R Gurudu¹⁰, Laith H Jamil¹¹, Terry L Jue¹², Mouen A Khashab¹³, Joanna K Law¹⁴, Jeffrey K Lee¹⁵, Mariam Naveed¹⁶, Mandeep S Sawhney¹⁷, Nirav Thosani¹⁸, Julie Yang¹⁹, Sachin B Wani²⁰

Affiliations

¹ Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
² Division of Gastroenterology/Hepatology, University of California, San Diego, California, USA.
³ Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA; Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA; Division of Gastroenterology, Hepatology & Nutrition, University of Florida College of Medicine, Gainesville, Florida, USA.
⁴ Section of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.
⁵ Department of Gastroenterology, Archbold Medical Group, Thomasville, Georgia, USA.
⁶ Norris Medical Library, University of Southern California, Los Angeles, California, USA (now with Children's Hospital Los Angeles, Los Angeles, California, USA).
⁷ Division of Hepatobiliary Surgery & Liver Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁸ Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁹ Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
¹⁰ Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Arizona, USA.
¹¹ Pancreatic and Biliary Diseases Program, Cedars-Sinai Medical Center, Los Angeles, California, USA.
¹² The Permanente Medical Group, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA.
¹³ Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA.
¹⁴ Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA.
¹⁵ Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA.
¹⁶ Division of Gastroenterology and Hepatology, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA.
¹⁷ Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
¹⁸ Division of Gastroenterology, Hepatology and Nutrition, McGovern Medical School, UTHealth, Houston, Texas, USA.
¹⁹ Division of Gastroenterology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
²⁰ Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA. Electronic address: [email protected].

Abstract

Each year choledocholithiasis results in biliary obstruction, cholangitis, and pancreatitis in a significant number of patients. The primary treatment, ERCP, is minimally invasive but associated with adverse events in 6% to 15%. This American Society for Gastrointestinal Endoscopy (ASGE) Standard of Practice (SOP) Guideline provides evidence-based recommendations for the endoscopic evaluation and treatment of choledocholithiasis. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to rigorously review and synthesize the contemporary literature regarding the following topics: EUS versus MRCP for diagnosis, the role of early ERCP in gallstone pancreatitis, endoscopic papillary dilation after sphincterotomy versus sphincterotomy alone for large bile duct stones, and impact of ERCP-guided intraductal therapy for large and difficult choledocholithiasis. 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-à-vis cholecystectomy, management of Mirizzi syndrome and hepatolithiasis, and biliary stent therapy for choledocholithiasis. Core clinical questions were derived using an iterative process by the ASGE SOP Committee. This body developed all recommendations founded on the certainty of the evidence, balance of risks and harms, consideration of stakeholder preferences, resource utilization, and cost-effectiveness.

Publication types

Practice Guideline
Research Support, N.I.H., Extramural

MeSH terms

Cholangiopancreatography, Endoscopic Retrograde*
Cholangiopancreatography, Magnetic Resonance
Cholecystectomy
Choledocholithiasis / diagnosis*
Choledocholithiasis / therapy*
Endosonography
Humans
Mirizzi Syndrome / diagnosis
Mirizzi Syndrome / therapy
Sphincterotomy, Endoscopic*
Stents

Grants and funding

U01 DK108334/DK/NIDDK NIH HHS/United States