If you have any questions or suggestions, please contact Customer Support at Info@asge.org. 2023 Feb 28;12(3):482. doi: 10.3390/antibiotics12030482. The role of endoscopy in the management of choledocholithiasis VOLUME 89, ISSUE 6, P1075-1105.E15 . Rent Institute for Training and Technology, The role of endoscopy in the management of choledocholithiasis, https://doi.org/10.1016/j.gie.2018.10.001, VOLUME 89, ISSUE 6, P1075-1105.E15, JUNE 01, 2019, /docs/default-source/importfiles/assets/0/71542/71544/6876dc5f-cb7b-40ff-98ef-7a954a051cc2.pdf?Status=Master&sfvrsn=2. (2020)Retrospective comparative analysis of choledochoscopic bile duct exploration versus ERCP for bile duct stones. 0000012563 00000 n Sci Rep. 2023 Mar 10;13(1):4032. doi: 10.1038/s41598-023-31206-6. Phone: (630) 573-0600 | Fax: (630) 963-8332 | Email: info@asge.org World J Gastroenterol. 0000094913 00000 n 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. Saline flushes, Fogarty catheters, stone retrieval baskets and the choledochoscope can then be used to facilitate clearance of the common bile duct. Tunruttanakul S, Chareonsil B, Verasmith K, Patumanond J, Mingmalairak C. JGH Open. Moon JH, Cho YD, Cha SW, Cheon YK, Ahn HC, Kim YS, Kim YS, Lee JS, Lee MS, Lee HK, Shim CS, Kim BS. Patients without evidence of jaundice and a normal bile duct on ultrasound have a low probability of choledocholithiasis (<5%) [9]. The revised categorization had a lower sensitivity and higher specificity of 37% and 80%, respectively. These recommendations will be based on existing data or a consensus of expert opinion when little or no data are available. An updated literature search from PubMed based on the prior published search strategy was performed from October 1, 2019 until March 16, 2021. acute biliary pancreatitis.8-11 The diagnostic approach to 0000007642 00000 n Exclusion criteria and risk stratification of included patients with suspected choledocholithiasis (CDL). 0000007171 00000 n Nevertheless, laparoscopic common bile duct exploration has not been adopted widely as it is technically challenging and strongly dependent on surgeon experience and equipment availability [19]. Am J Gastroenterol. cholangiography (IOC) at elective cholecystectomy https://doi.org/10.1016/j.gie.2020.10.033. 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. 2023 Mar 27;85(4):659-664. doi: 10.1097/MS9.0000000000000124. Intermediate risk of choledocholithiasis: are we on the right path? Evaluating the accuracy of American Society for Gastrointestinal HHS Vulnerability Disclosure, Help Accessibility Whenever possible, guidelines are based on the GRADE(Grading of Recommendation Assessment, Development and Evaluation) methodology. If the patient is found to have a retained stone post-operatively, ERCP is the treatment of choice for biliary clearance. 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. Forest plot of randomized trials comparing endoscopic sphincterotomy followed by large balloon dilation versus endoscopic sphincterotomy for stone clearance. Eleanor C. Fung is a consultant for Boston Scientific and has received travel reimbursements from Cook Medical and Fujifilm. 0000004317 00000 n Each year choledocholithiasis results in biliary obstruction, cholangitis, and pancreatitis in a signicant number of patients. 2002 Jan 14-16;19(1):1-26. Acta Gastroenterol Belg. xref Background: Recent guidelines from the European Society of Gastrointestinal Endoscopy (ESGE) and American Society for Gastrointestinal Endoscopy (ASGE) recommend risk stratification according to liver function test (LFT) and abdominal ultrasound in patients with suspected choledocholithiasis. doi: 10.1371/journal.pone.0282899. ERCP has a success rate of approximately 8090% for ductal clearance with proper expertise. risk of pancreatitis (25%-36%)13,14 or cholangitis if they -. ASGE guideline on the role of endoscopy in the evaluation and Another well-reported method includes the staged rendez-vous procedure in which the interventional radiologist is able to place a percutaneous transhepatic guidewire that is fed retrograde through the papilla into the duodenum that can then be accessed by the duodenoscope for cannulation [26]. Of these 25 patients, 9 patients had choledocholithiasis, 9 patients had sludge and 7 patients had a normal ERCP. If you are member, please. 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]. It is very important that you consult your doctor about your specific condition. Jang SI, Kim DU, Cho JH, et al. Asymptomatic Choledocholithiasis that Causes a Dilemma between <<67E2DCD2A76882419F2334789E285828>]>> Each recommendation is based on consideration of the best medical literature, the balance between risks and benefits, cost-effectiveness, patients values, and equity. 0000100990 00000 n Lei Y, Lethebe BC, Wishart E, Bazerbachi F, Elmunzer BJ, Thosani N, Buxbaum JL, Chen YI, Bass S, Cole MJ, Turbide C, Brenner DR, Heitman SJ, Mohamed R, Forbes N. J Clin Med. 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. When financial guidance is indicated, the most recent coding data and list prices at the time of publication are provided. Predicting common bile duct stones: Comparison of SAGES, ASGE and ESGE criteria for accuracy. ASGE | The role of endoscopy in the management of choledocholithiasis recommended. -, Savides TJ. Gastrointest Endosc 39:528531, Koornstra JJ, Fry L, Monkemuller K (2008) ERCP with the balloon-assisted enteroscopy technique: a systematic review. Laparoscopic common bile duct exploration combined with cholecystectomy is a feasible and effective option as a single-stage procedure for the management of choledocholithiasis. Whenever possible, guidelines are based on the GRADE(Grading of Recommendation Assessment, Development and Evaluation) methodology. J Hepatobiliary Pancreat Sci 25:3140, Mukai S, Itoi T, Baron TH, Takada T, Strasberg SM, Pitt HA, Ukai T, Shikata S, Teoh AYB, Kim MH, Kiriyama S, Mori Y, Miura F, Chen MF, Lau WY, Wada K, Supe AN, Gimnez ME, Yoshida M, Mayumi T, Hirata K, Sumiyama Y, Inui K, Yamamoto M (2017) Indications and techniques of biliary drainage for acute cholangitis in updated Tokyo Guidelines 2018. PMC 0000006068 00000 n 0000101495 00000 n World J Gastroenterol 16:5388-5390, Ogura T, Higuchi K (2015) Technical tips of endoscopic ultrasound-guided choledochoduodenostomy. 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. 0000099052 00000 n 2020 ASGE. ASGE guidelines in patients with AGP. Choledocholithiasis refers to the presence of gallstones within the common bile duct. In 2010, the American Society for Gastrointestinal Endoscopy (ASGE) suggested a management algorithm based on probability for choledocholithiasis, recommending additional imaging for patients at intermediate risk . Supisara Tintara, Ishani Shah, William Yakah, Awais Ahmed, Cristina S Sorrento, Cinthana Kandasamy, Steven D Freedman, Darshan J Kothari, Sunil G Sheth. Gastrointest Endosc 44:450459, Yang MH, Chen TH, Wang SE, Tsai YF, Su CH, Wu CW, Lui WY, Shyr YM (2008) Biochemical predictors for absence of common bile duct stones in patients undergoing laparoscopic cholecystectomy. 0000101985 00000 n Surg Endosc. Endoscopic Retrograde Cholangiopancreatography and Endoscopic 0000007249 00000 n 0000003310 00000 n We identified high-risk patients according to the original and revised guidelines and examined the diagnostic accuracy of both guidelines. Yu CY, Roth N, Jani N, Cho J, Van Dam J, Selby R, Buxbaum J. Surg Endosc. 0000099565 00000 n 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. Exclusion criteria and risk stratification, Exclusion criteria and risk stratification of included patients with suspected choledocholithiasis (CDL). Here you will find ASGE guidelines for standards of practice. We performed a systematic review with . This has been associated, however, with an increased complication rate of 530%, which include perforation and post-ERCP pancreatitis [18]. Surg Endosc 15:413, Bansal VK, Misra MC, Rajan K, Kilambi R, Kumar S, Krishna A, Kumar A, Pandav CS, Subramaniam R, Arora MK, Garg PK (2013) Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with concomitant gallbladder stones and common bile duct stones: A randomized controlled trial. Maple JT, Ben-Menachem T, et al. Nonoperative imaging techniques in suspected biliary tract obstruction. ASGE guideline on the role of endoscopy in the evaluation and Chandran A, Rashtak S, Patil P, et al. 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]. The visualization of a common bile duct stone on abdominal ultrasound carries approximately a 73% sensitivity and 91% specificity according to a meta-analysis of five studies [6]. Due to the difficulty in navigation and subsequent cannulation, balloon-assisted ERCP is not always technically feasible for biliary duct clearance in these patients. A biliary sphincterotome can then be back-loaded over the guidewire to allow for direct cannulation of the common bile duct followed by stone extraction through a single-stage laparoscopic-endoscopic approach [21]. 1,3 The ASGE recommends upper endoscopy if the results are likely to influence management of the patient, if empiric treatment for a suspected benign disorder has been unsuccessful, if the procedure can be used as an alternative to . Choledocholithiasis is a commonly encountered diagnosis for general surgeons. 0000004540 00000 n Sperna Weiland CJ, Verschoor EC, Poen AC, Smeets XJMN, Venneman NG, Bhalla A, Witteman BJM, Timmerhuis HC, Umans DS, van Hooft JE, Bruno MJ, Fockens P, Verdonk RC, Drenth JPH, van Geenen EJM; Dutch Pancreatitis Study Group. Thieme E-Journals - Endoscopy / Abstract Comparing diagnostic accuracy of current practice guidelines in The detection of bile duct stones in suspected biliary pancreatitis: comparison of MRCP, ERCP, and intraductal US. Questions. In the case that endoscopic retrieval is unsuccessful, percutaneous biliary drainage or less frequently laparoscopic or open common bile duct exploration may be required. A naso-biliary drain is inserted by radiology to allow for fluoroscopic identification and targeting of the common bile duct stones. 8600 Rockville Pike Stone visualized on imaging had the greatest specificity for choledocholithiasis. Scand J Gastroenterol 53:13881392, Hope WW, Fanelli R, Walsh DS, Narula VK, Price R, Stefanidis D, Richardson WS (2017) SAGES clinical spotlight review: intraoperative cholangiogram. Gallstone disease affects more than 20 million American adults2 at an annual cost of $6.2 billion.3 The incidence of choledocholithiasis ranges from 5% to 10% in those patients undergoing laparoscopic cholecystectomy for symptomatic cholelithiasis4-7 to 18% . Panels consist of content experts, stakeholders from other specialties, patient representatives, and members of the ASGE Standards of Practice (SOP) Committee. eCollection 2023. %%EOF 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. NIH state-of-the-science statement on endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis and therapy. 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. 0000007803 00000 n Phone: (630) 573-0600 | Fax: (630) 963-8332 | Email: info@asge.org This demonstrated that the use of the revised guidelines in assessing risk for choledocholithiasis in AGP patients can lead to a decrease in . See this image and copyright information in PMC. This study aimed to assess the diagnostic performance of the revision and to compare it to the previous guidelines. The positive predictive value of the high-risk categorization increased with the revision, reflecting a potential decrease in diagnostic endoscopic retrograde cholangiopancreatograpies (ERCPs). 0000101667 00000 n Endoscopy. 0000098842 00000 n Laparoscopic cholecystectomy in super elderly (>90years of age): safety and outcomes. Gut 57:10041021, Grubnik VV, Tkachenko AI, Ilyashenko VV, Vorotyntseva KO (2012) Laparoscopic common bile duct exploration versus open surgery: comparative prospective randomized trial. All Rights Reserved. stones incidentally discovered during routine intraoperative webmaster@sages.org Results: Three hundred twenty-seven patients had an intermediate risk for choledocholithiasis. National Library of Medicine The categorization had a sensitivity and specificity of 68% and 55%, respectively, for the detection of choledocholithiasis. Reasons for failure include large or impacted stones, duodenal diverticula, altered gastric or duodenal anatomy and intrahepatic stones. Conflicts of Interest: The authors have no potential conflicts of interest. If plans are made intraoperatively for post-operative ERCP for common bile duct stone clearance, additional measures, such as endoloops or additional laparoscopic clips on the cystic duct stump and an external drain in the gallbladder fossa, should be considered to protect against leakage of the cystic duct stump due to the higher pressures present in the biliary tree. In this retrospective study, the authors compared the performance of two such guidelines published by the American Society for Gastrointestinal Endoscopy (ASGE) in 2010 and 2019. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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. Surg Endosc 32:26032612, Dasari BV, Tan CJ, Gurusamy KS, Martin DJ, Kirk G, McKie L, Diamond T, Taylor MA (2013) Surgical versus endoscopic treatment of bile duct stones. Depiction of endoscopic ultrasound-directed transgastric ERCP (EDGE) to perform ERCP following Roux-en-Y gastric bypass. Saito H, Iwasaki H, Itoshima H, Kadono Y, Shono T, Kamikawa K, Urata A, Nasu J, Uehara M, Matsushita I, Kakuma T, Tada S. Dig Dis Sci. ASGE evidence-based guidelines provide clinicians with recommendations for the evaluation, diagnosis, and management of patients undergoing endoscopic procedures of the digestive tract. Methods An observational retrospective study including hospitalized patients admitted with acute cholecystitis between January 2016 and December 2020 at Edit Wolfson Medical Center. 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. The treatment strategy for biliary drainage should be decided in consideration of the patients general status. patients with suspected choledocholithiasis is addressed 83(4):577-584. Gastrointest Endosc 2020 Nov 4. Clipboard, Search History, and several other advanced features are temporarily unavailable. 3,4,8,9 Not surprisingly, many practice patterns now exist to manage CBD stones, which has led to national debate regarding the optimal algorithm. Surgical drainage and management is generally rare and not advocated in these critically ill patients due to the increased morbidity and mortality compared to endoscopic treatment in this patient population [40]. The site is secure. 0000011611 00000 n HPB (Oxford) 2006;8:409425.