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

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

doi:10.1016/j.gie.2018.10.001

Cited by 410 publications

(398 citation statements)

References 125 publications

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“…Even though choledocholithiasis remains the most common indication for ERCP, the proportion of ERCP in patients with acute biliary pancreatitis has decreased. This is expected and consistent with other recent studies, since consensus guidelines recommend that ERCP should only be performed in acute biliary pancreatitis patients if they have cholangitis or have documented or increased suspicion of choledocholithiasis [21,22]. Interestingly, our analysis showed that a greater number of ERCPs are being performed for cholangitis now as compared to 10 years ago.…”

Section: Unadjustedsupporting

confidence: 92%

“…Also, much more widespread availability and options for biliary stents are also likely contributing to this. In regards to the increased use of PD stent placements over the past decade, this is likely due to overwhelming data showing reduction in PEP after PD stent placement [22]. On the other hand, increased use of PD stent placement could also be due to increased undertaking of ERCP for therapy of pancreatic diseases.…”

Section: Unadjustedmentioning

confidence: 99%

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Use of ERCP in the United States over the past decade

et al. 2020

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Background and study aims With newer imaging modalities, indications for use of endoscopic retrograde cholangiopancreatography (ERCP) have changed in the last decade. Despite advances in ERCP, paucity in recent literature regarding utilization and outcomes of ERCP exists. Thus, the aim of this study was to assess the inpatient use of ERCP, outcomes, and most common indications. Patients and methods Retrospective-cohort study using the Nationwide Inpatient Sample 2007–2016. All patients with ICD9–10CM procedural codes for ERCP were included. The primary outcome was the use of ERCP. Secondary outcomes included determining procedural specifics (stenting, sphincterotomy and dilation), complications (post-ERCP pancreatitis [PEP], bile duct perforation), hospital length of stay, total hospital costs and charges. Multivariate regression analysis was used to adjust for confounders. Results A total of 1,606,850 patients underwent inpatient ERCP. The mean age was 59 years (60 % female). The total number of ERCPs increased over the last decade. Patients undergoing ERCP in 2016 had greater odds of undergoing bile duct stent placement, pancreatic duct (PD) stenting, biliary dilation, pancreatic sphincterotomy, PEP and biliary perforation. Inpatient mortality decreased. Hospital charges increased, while length of stay (LOS) decreased. Conclusions The number of ERCPs increased in the past decade. Odds of therapeutic interventions and complications increased. The most common principal diagnoses were choledocholithiasis and gallstone-related AP. Hence, physicians must be aware to promptly diagnose and treat complications. These findings may reflect the increased case complexity and fact that ERCP continues to evolve into an increasingly interventional tool, contrasting from its former role as a predominantly diagnostic and gallstone extraction tool.

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Section: Unadjustedsupporting

confidence: 92%

Section: Unadjustedmentioning

confidence: 99%

Use of ERCP in the United States over the past decade

et al. 2020

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“…In the American Society for Gastrointestinal Endoscopy guideline, clinical situations associated with difficult bile duct stone extraction were (1) stone larger than 15 mm, (2) stone that cannot be captured in the basket or mechanical lithotripsy, (3) stone with complex biliary stricture, (4) stone in patients with altered upper gut anatomy, and (5) Mirizzi's syndrome. 15 However, Ödemiş et al defined difficult stones as the stones that cannot be extracted in the first ERCP procedure using the standard technique; this was similar to the term for the successful procedure, not for a difficult stone, in our study. 4 We divided patients into an easy group and a difficult stone group according to the criteria proposed in a previous study.…”

Section: Discussionsupporting

confidence: 52%

“…9,10 On the other hand, the improvement of endoscopic technique such as mechanical lithotripsy, laser lithotripsy, and cholangioscopy made ERCP the popular choice. [11][12][13][14][15][16] ERCP with standard stone removal technique is the simplest procedure in endoscopy that most of the hospital can perform, whereas laser lithotripsy is available only in some tertiary centers especially in a low-or middle-income country. [17][18][19] It would be beneficial to the treatment planning if the success or failure of ERCP with the standard stone removal can be predicted, and a patient with a higher risk of OC conversion can be identified.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with the Success Rate of Endoscopic Retrograde Cholangiopancreatography with Standard Technique followed by Laparoscopic Cholecystectomy in the Management of Choledocholithiasis: A Single-Center Experience

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Eurboonyanun

Ruangwannasak

et al. 2020

Journal of Digestive Endoscopy

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Abstract Background Choledocholithiasis is the most common benign biliary disease. Endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) has been the first-line therapy in recent years, although laparoscopic common bile duct exploration has promising results. This retrospective study aimed to define the factors associated with biliary clearance by standard ERCP technique and conversion rate of LC. Materials and Methods We retrospectively evaluated the records of 217 choledocholithiasis patients who had undergone ERCP with stone removal by the standard technique from 2010 to 2018. A failed ERCP was defined when the first ERCP session could not remove the stones . The number of patients who later underwent open cholecystectomy or LC was also recorded. Conversion was defined when LC had to be converted OC. Statistical Analysis Student’s t-test was used for the comparison of continuous variables. Nominal variables were analyzed using Pearson’s chi-square test or Fisher’s exact test. Binary logistic regression was performed for multivariate analysis. Results The rate of successful biliary clearance was 81.1%. Of the patients, 109 (50.2%) had difficult stones. Increasing age (p = 0.004), increasing number (p = 0.001), and increasing size of stone (p < 0.001) were the three significant factors that were associated with the failure of biliary clearance. The difficult stone group had a higher failure rate of ERCP and a higher conversion rate of LC compared with the easy stone group (p = 0.001 and p = 0.027, respectively). Conclusions ERCP with the standard technique is a highly effective and safe management option for patients with common bile duct (CBD) stones. The difficult stone group was found to be an independent risk factor that affected the success rate of both ERCP and the following LC. Difficult stone criteria should be assessed to identify a patient who might benefit from laparoscopic CBD exploration.

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“…Secondly, we recommend that IOC be performed more routinely where appropriate, allowing patients to have cholecystectomy and bile duct analysis as one procedure. The benefit of this is threefold: it relieves pressure on MRCP services (which are not always widely available), reduces pre-operative investigatory delays, and can shorten length of stay (46,119). Stricter MRCP use has also been shown to reduce cost (120,121).…”

Section: Proposed Ways Of Reducing Time To Cholecystectomymentioning

confidence: 99%

Cholecystectomy for Complicated Gallbladder and Common Biliary Duct Stones: Current Surgical Management

et al. 2020

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Gallstone disease accounts for the vast majority of acute surgical admissions in the UK, with a major treatment being cholecystectomy. Practice varies significantly as to whether surgery is performed during the acute symptomatic phase, or after a period of recovery. Differences in practice relate to operative factors, patient factors, surgeon factors and hospital and trust wide policies. In this review we summarize recent evidence on management of gallstone disease, particularly with respect to whether cholecystectomy should occur during index presentation or following recovery. We highlight morbidity and mortality studies, cost, and patient reported outcomes. We speculate on barriers to change in service delivery. Finally, we propose potential solutions to optimize care.

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

Cited by 410 publications

References 125 publications

Use of ERCP in the United States over the past decade

Use of ERCP in the United States over the past decade

Factors Associated with the Success Rate of Endoscopic Retrograde Cholangiopancreatography with Standard Technique followed by Laparoscopic Cholecystectomy in the Management of Choledocholithiasis: A Single-Center Experience

Cholecystectomy for Complicated Gallbladder and Common Biliary Duct Stones: Current Surgical Management

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