asge guidelines choledocholithiasis asge guidelines choledocholithiasis

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]. Methods: Risks associated with ERCP include pancreatitis (1.36.7%), infection (0.65%), hemorrhage (0.32%), perforation (0.11%) and mortality (up to 1%) [10]. It then conducted a PubMed search of all English language articles in October 2019 published using the medical subject heading (MeSH) search terms common bile duct stones, choledocholithiasis, ERCP/endoscopic retrograde cholangiopancreatography, common bile duct exploration, diagnosis and management. Careers. Vimal K. Narula, D. Wayne Overby, William Richardson, and Dimitrios Stefanidis have no conflicts of interest or financial ties to disclose. Forty articles were found of which six were directly relevant to the prior clinical review recommendations. We found that 2/3 of patients in the intermediate group and 83% of patients in the high risk group followed ASGE guidelines for management of choledocholithiasis in the . 0000101239 00000 n In 2019, the American Society for Gastrointestinal Endoscopy (ASGE) guideline on the endoscopic management of choledocholithiasis modified the individual predictors of choledocholithiasis proposed in the widely referenced 2010 guideline to improve predictive performance. This American Society for Gastrointestinal Endoscopy (ASGE) Standard of Practice (SOP) Guideline . and transmitted securely. Alternatively, a small caliber choledochoscope with a working channel can be passed through the cystic duct into the common bile duct where a basket stone extractor can then be used to capture the stones under direct visualization [16]. In addition, laparoscopic common bile duct (CBD) exploration with cholecystectomy reduces utilization of ERCP and long-term rates of CBD stone recurrence compared to endoscopic management with ERCP and sphincterotomy alone [2]. Ann Surg 220:3239, Abboud PAC, Malet PF, Berlin JA, Staroscik R, Cabana MD, Clarke JR, Shea JA, Schwartz JS, Williams SV (1996) Predictors of common bile duct stones prior to cholecystectomy: a meta-analysis. If the patient is undergoing a pre-operative ERCP and endoscopic attempts with balloon or basket sweeping are unsuccessful, mechanical lithotripsy by way of capturing and fragmenting stones with a reinforced basket with a spiral sheath can be successful in over 80% of cases [28,29]. 2023 Feb;37(2):1194-1202. doi: 10.1007/s00464-022-09615-x. A naso-biliary drain is inserted by radiology to allow for fluoroscopic identification and targeting of the common bile duct stones. %PDF-1.4 % Web Design and Development by Matrix Group International, Inc. Gallstone disease affects more than 20 million American Management algorithm for patients based on probability of choledocholithiasis. Epub 2019 Mar 25. Epub 2016 Jun 14. 0000015193 00000 n 3. Officers and Representatives of the Society, RAFT Annual Meeting Abstract Contest and Awards, 2024 Scientific Session Call For Abstracts, 2024 Emerging Technology Call For Abstracts, Healthy Sooner Patient Information for Minimally Invasive Surgery, Choosing Wisely An Initiative of the ABIM Foundation, All in the Recovery: Colorectal Cancer Alliance, SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice, Surgical Endoscopy and Other Journal Information, NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy, SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy, Multi-Society Foregut Fellowship Certification, SAGES Go Global: Global Affairs and Humanitarian Efforts. We suggest that the reader also reviews the SAGES clinical spotlight review on laparoscopic common bile duct exploration for further details [16]. All Rights Reserved. This has been associated, however, with an increased complication rate of 530%, which include perforation and post-ERCP pancreatitis [18]. Stone visualized on imaging had the greatest specificity for choledocholithiasis. This American Society for Gastrointestinal Endoscopy (ASGE) Standard of Practice (SOP) Guideline provides evidence-based recommendations for the endoscopic evaluation and treatment of choledocholithiasis. 9-11 The primary . Obes Surg 29:451456, Bertin PM, Singh K, Arregui ME (2011) Laparoscopic transgastric endoscopic retrograde cholangiopancreatography (ERCP) after gastric bypass: Case series and a description of technique. These recommendations will be based on existing data or a consensus of expert opinion when little or no data are available. reviewing Chandran A, et al. 2017 Sep;86(3):525-532. doi: 10.1016/j.gie.2017.01.039. 0000005334 00000 n 0000100613 00000 n 0000008123 00000 n Gastrointest Endosc 83:10611075. cholangiography (IOC) at elective cholecystectomy ASGE guidelines in choledocholithiasis 87 Annals of Gastroenterology 29 predictor, and 5 had two strong predictors for a total of 14 high-risk patients. 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]. Among more than 10,000 ERCPs performed in a 14-hospital system over 7 years, 744 cases were randomly selected from those performed for suspected choledocholithiasis, while excluding those with a prior cholecystectomy or sphincterotomy. ASGE quality indicators are based on a rigorous review process which results in valid metrics for evaluating GI endoscopic procedures. 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. GUIDELINE The role of endoscopy in the evaluation of suspected choledocholithiasis This is one of a series of statements discussing the use of GI endoscopy in common clinical situations. In this method, energy is delivered directly to a large or impacted stone under direct visualization with the aid of continuous irrigation of the CBD. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to rigorously review and synthesize the . 2010;71:19. 0000005448 00000 n 0000004427 00000 n Regardless, the surgeon must be familiar with all possible options at their disposal for managing the patient presenting with choledocholithiasis which are highlighted in this document. Under the revised guidelines, 86 (32%) patients met the criteria for high risk, of whom 83% had choledocholithiasis. J Laparoendosc Adv Surg Tech A. This site needs JavaScript to work properly. 0000039156 00000 n See this image and copyright information in PMC. (2020)Retrospective comparative analysis of choledochoscopic bile duct exploration versus ERCP for bile duct stones. patients with known choledocholithiasis. 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. However, in patients with advanced comorbidities who are at significantly high risk for operative intervention, ERCP with sphincterotomy without any further subsequent intervention can also be considered definitive therapy, as there has been no statistical difference in mortality [11,12]. In 2000 and 2012, the American Society of Gastrointestinal Endoscopy (ASGE) issued guidelines regarding the performance of upper GI endoscopy. 0000102101 00000 n Kogure H, Kawahata S, Mukai T, et al. Electrohydraulic lithotripsy involves shock waves that are delivered in brief pulses directly at the stone by the probe, which is optimally located approximately 12mm from the stone. 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. Unable to load your collection due to an error, Unable to load your delegates due to an error. 0000011611 00000 n 0000100990 00000 n If these endoscopic approaches prove unsuccessful, a common bile duct exploration or PTBD with its associated percutaneous interventions can then be performed for common bile duct clearance, which have been described earlier in this document. Under the original guidelines, 165 (62%) patients met the criteria for high risk, of whom 79% had confirmed choledocholithiasis. PMC The https:// ensures that you are connecting to the Although data regarding the natural history of choledocholithiasis Gallstone disease: epidemiology of gallbladder stone disease. Overall, ERCP identified definite stones in 73.1% of patients and stone or sludge in 93.5% of cases. Wongkanong C, Patumanond J, Ratanachu-Ek T, Junrungsee S, Tantraworasin A. PLoS One. Evaluating the accuracy of American Society for Gastrointestinal Endoscopy guidelines in patients with acute gallstone pancreatitis with choledocholithiasis. Sci Rep. 7;10(1):14736. 0000002496 00000 n The American Society for Gastrointestinal Endoscopy (ASGE) 2010 guidelines for suspected choledocholithiasis were recently updated by proposing more specific criteria for selection of high-risk patients to undergo direct ERCP while advocating the use of additional imaging studies for intermediate- and low-risk individuals. 0000005106 00000 n Sci Rep. 2023 Mar 10;13(1):4032. doi: 10.1038/s41598-023-31206-6. Past studies have demonstrated greater safety and reduced costs when ERCP is reserved for therapeutic application in patients with a high likelihood of duct stones, as opposed to performance as a diagnostic and potentially therapeutic intervention among those with low to intermediate risk of stones. Gastrointest Endosc 2020 Nov 4. Yu CY, Roth N, Jani N, Cho J, Van Dam J, Selby R, Buxbaum J. Surg Endosc. See this image and copyright information in PMC. Br J Surg 78:14481450, Cipolletta L, Coastamagna G, Bianco MA, Rotondano G, Piscopo R, Mutignani M, Marmo R (1997) Endoscopic mechanical lithotripsy of difficult common bile duct stones. 0000003105 00000 n Accuracy of ASGE high-risk criteria in evaluation of patients with suspected common bile duct stones. Tintara S, Shah I, Yakah W, Ahmed A, Sorrento CS, Kandasamy C, Freedman SD, Kothari DJ, Sheth SG. In summary, patients predicted to be at high risk for choledocholithiasis based on ASGE guidelines met the threshold of at least a 50% likelihood of having persistent choledocholithiasis. 0000007562 00000 n 0000008437 00000 n Gut 57:10041021, Grubnik VV, Tkachenko AI, Ilyashenko VV, Vorotyntseva KO (2012) Laparoscopic common bile duct exploration versus open surgery: comparative prospective randomized trial. Gastrointest Endosc 86:986993, Gurusamy KS, Giljaca V, Takwoingi Y, Higgie D, Poropat G, timac D, Davidson BR (2015) Ultrasound versus liver function tests for diagnosis of common bile duct stones. PMC This study aimed to assess the diagnostic performance of the revision and to compare it to the previous guidelines. 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. may be less morbid than symptomatic CBD stones discovered 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. With great interest, we read the study analyzing the diagnostic accuracy of current practice guidelines in predicting choledocholithiasis.1 The authors showed that the 2019 guidelines provided higher specificity for detecting choledocholithiasis.2,3 With current practice guidelines, the risk to the patient receiving diagnostic ERCP can be reduced. 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]. NIH state-of-the-science statement on endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis and therapy. Summary of Evidence. ASGE guideline on screening and surveillance of Barrett's esophagus. ASGE high likelihood criteria had sensitivity and specificity 0000045574 00000 n This site needs JavaScript to work properly. Definitive . 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. There are no specific recommendations for cholecystectomized . Numerous factors have been implicated as prognostic predictors to help stratify patients into low, intermediate and high probability of choledocholithiasis. 2016 Jul;48(7):657-83. doi: 10.1055/s-0042-108641. -, Tse F, Barkun JS, Romagnuolo J, Friedman G, Bornstein JD, Barkun AN. Phone: (630) 573-0600 | Fax: (630) 963-8332 | Email: info@asge.org That previous ASGE guideline, much like the recent guideline from the European Society of Gastrointestinal Endoscopy (ESGE) on this topic (NEJM JW Gastroenterol April 5 2019; [e-pub] and Endoscopy 2019 Apr 3; [e-pub]), was a narrative . It is very important that you consult your doctor about your specific condition. Each recommendation is based on consideration of the best medical literature, the balance between risks and benefits, cost-effectiveness, patients values, and equity. Nevertheless, the primary literature, especially for the 2019 iteration, is limited. 0000003388 00000 n Guidelines are applicable to all physicians who address the clinical problem(s) without regard to specialty training or interests, and are intended to indicate the preferable, but not necessarily the only acceptable approaches due to the complexity of the healthcare environment. Keywords: government site. Choledocholithiasis is a common presentation of symptomatic cholelithiasis that can result in biliary obstruction, cholangitis, and pancreatitis. 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 American Society for Gastrointestinal Endoscopy (ASGE) Standard of Practice (SOP) Guideline provides evidence-based recommendations for the endoscopic evaluation and treatment of choledocholithiasis. We identified high-risk patients according to the original and revised guidelines and examined the diagnostic accuracy of both guidelines. Testoni PA, Mariani A, Aabakken L, Arvanitakis M, Bories E, Costamagna G, Devire J, Dinis-Ribeiro M, Dumonceau JM, Giovannini M, Gyokeres T, Hafner M, Halttunen J, Hassan C, Lopes L, Papanikolaou IS, Tham TC, Tringali A, van Hooft J, Williams EJ. Buxbaum JL, Abbas Fehmi SM, Sultan S. ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis . ASGE guidelines in patients with AGP. 8600 Rockville Pike Surg Endosc 22:16201624, ASGE Standards of Practice Committee JT Maple T Ben-Menachem MA Anderson V Appalaneni S Banerjee BD Cash L Fisher ME Harrison RD Fanelli N Fukami SO Ikenberry R Jain K Khan ML Krinsky L Strohmeyer JA Dominitz (2010) The role of endoscopy in the evaluation of suspected choledocholithiasis. Half the patients were at least 65 years old. Each recommendation is based on consideration of the best medical literature, the balance between risks and benefits, cost-effectiveness, patients values, and equity. Please enable it to take advantage of the complete set of features! Biliary tract disease; Choledocholithiasis; Endoscopic retrograde cholangiopancreatography; Endoscopic ultrasound; Magnetic resonance cholangiopancreatography. . 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. Test Performance Characteristics of Dynamic Liver Enzyme Trends in the Prediction of Choledocholithiasis. HHS Vulnerability Disclosure, Help addresses the role of endoscopy in the management of Clipboard, Search History, and several other advanced features are temporarily unavailable. ASGE Guideline for the Management of Post-Liver Transplant Biliary Strictures, ASGE Guideline on the Role of Ergonomics to Prevent Injuries for the Endoscopist, ASGE guideline on the Role of Endoscopy in the Diagnosis of Biliary Strictures, ASGE Guideline on the Role of Endoscopic Submucosal Dissection in the Management of Esophageal and Gastric Mucosal Neoplasia. Choledocholithiasis is a common presentation of symptomatic cholelithiasis that can result in biliary obstruction, cholangitis, and pancreatitis. 0000100916 00000 n Here you will find ASGE guidelines for standards of practice. This American Society for Gastrointestinal Endoscopy (ASGE) Standard of Practice (SOP) Guideline provides evidence-based recommendations for the endoscopic evaluation and treatment of choledocholithiasis. Guidelines for clinical practice are intended to indicate preferable approaches to medical problems as established by experts in the field. Example of an antegrade common bile duct stent that can be inserted laparoscopically under fluoroscopic guidance to allow for biliary drainage, if biliary clearance cannot be achieved intraoperatively. There are also through the scope choledochoscopes (e.g., Spyglass) that are now available that can administer intracorporeal electrohydraulic or laser lithotripsy. The content in this bundle consists of some of the best GIE articles and video clips related to best practices and recommended guidelines. If the initial ductotomy made for cholangiogram is too small, the ductotomy can either be extended closer to the cystic duct-CBD junction or pneumatic cystic duct dilatation can be performed under fluoroscopy over a guidewire. Quality documents define the indicators of high-quality endoscopy and how to measure it. He H, Tan C, Wu J, Dai N, Hu W, Zhang Y, Laine L, Scheiman J, Kim JJ. ASGE classified 58 (8.6 %) additional patients as intermediate, none . Quality documents define the indicators of high-quality endoscopy and how to measure it. The subtleties in the management of common bile duct stones relate to the decision making on the probability of choledocholithiasis based on clinical presentation and investigations, the timing of presentation in relation to laparoscopic cholecystectomy in addition to the availability of technology and expertise of the surgeons, endoscopists and interventional radiologists. 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. Choledocholithiasis has a prevalence of approximately 1015% of patients with symptomatic cholelithiasis [1]. In the case that endoscopic retrieval is unsuccessful, percutaneous biliary drainage or less frequently laparoscopic or open common bile duct exploration may be required. Optimal Predictive Criteria for Common Bile Duct Stones: The Search Continues. The working group first determined questions relevant to the clinical practice of surgeons treating patients with choledocholithiasis. 0000014239 00000 n 24.77% were diagnosed with 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. Girn F, Rodrguez LM, Conde D, Rey Chaves CE, Vanegas M, Venegas D, Gutirrez F, Nassar R, Hernndez JD, Jimnez D, Nez-Rocha RE, Nio L, Rojas S. Ann Med Surg (Lond). Quality documents define the indicators of high-quality endoscopy and how to measure it. 2002 Jan 14-16;19(1):1-26. Based on initial laboratory data and imaging findings, each patient was categorized as low/intermediate probability or high probability of choledocholithiasis as per both 2010 and 2019 ASGE guideline criteria ().The 2019 guidelines consider CBD stones on abdominal US or cross-sectional imaging or clinical ascending cholangitis or total bilirubin >4 mg/dL along with a dilated CBD as high . Laparoscopic cholecystectomy in super elderly (>90years of age): safety and outcomes. 0000100313 00000 n Laser lithotripsy involves laser light of a high-power density, traditionally Holmium:Yttrium-aluminum-garnet (YAG) laser, is aimed directly on the surface of a stone, creating a plasma gaseous collection of ions and free electrons that then induces oscillation and cavitation that shatter the stone surface [30]. AExample of a percutaneous transhepatic biliary drain which can either be an external biliary drain in the intrahepatic ducts or an internal/external biliary drain that traverses the ampulla into the duodenum. <<67E2DCD2A76882419F2334789E285828>]>> ASGE Standards of Practice Committee, Maple JT, Ikenberry SO, Anderson MA, Appalaneni V, Decker GA, et al: The role of endoscopy in the management of choledocholithiasis. Technology evaluations provide a review of existing, new, or emerging endoscopic technologies that have an impact on the practice of GI endoscopy. Surg Endosc 31:20072016, Ohtani T, Kawai C, Shirai Y, Kawakami K, Yoshida K, Hatakeyama K (1997) Intraoperative ultrasonography versus cholangiography during laparoscopic cholecystectomy: a prospective comparative study. Gastrointest Endosc 2011;74:731-744. Privacy Policy | Terms of Use risk of pancreatitis (25%-36%)13,14 or cholangitis if they ASGE Guideline for the Management of Post-Liver Transplant Biliary Strictures, ASGE Guideline on the Role of Ergonomics to Prevent Injuries for the Endoscopist, ASGE guideline on the Role of Endoscopy in the Diagnosis of Biliary Strictures, ASGE Guideline on the Role of Endoscopic Submucosal Dissection in the Management of Esophageal and Gastric Mucosal Neoplasia. Treatment of recurrent common bile duct stones typically includes repeat endoscopic intervention (i.e., ERCP) but may also be treated surgically in patients who are at high risk of recurrence. Here you will find ASGE guidelines for standards of practice. If this is not successful, stones can be extracted with a wire basket or Fogarty balloons under fluoroscopic guidance. Conflicts of Interest: The authors have no potential conflicts of interest. 0000102312 00000 n 0000101899 00000 n Although these techniques have high success rates, there is a significant risk of bleeding via the transhepatic tract and it can also cause patient discomfort as well as dehydration secondary to fluid losses. Endoscopic ultrasound-guided biliary drainage via choledochoduodenostomy is also another documented method of accessing the common bile duct in which the common bile duct is directly punctured via a transduodenal approach to both clear and stent the common bile duct but this does require advanced endoscopic expertise [27]. Chvez Rossell MA. The first edition of "Clinical practice guidelines for the treatment of cholelithiasis," published in 2009, was developed on the basis of documented evidence published from 1983 to 2007 and consisted of chapters on epidemiology and pathology, diagnosis, treatments (separate sections for cholecystolithiasis, choledocholithiasis, and hepatolithiasis), and prognosis and complications. Conclusion: Systematic review and meta-analysis of the 2010 ASGE non-invasive predictors of choledocholithiasis and comparison to the 2019 ASGE predictors. Relative contraindications to the transcystic approach include a small, friable cystic duct, multiple stones in the common bile duct, stones larger than 1cm or stones in the proximal duct [16,22].