Evidence-based clinical practice guidelines for cholelithiasis 2016

Abstract

Cholelithiasis is one of the commonest diseases in gastroenterology. Remarkable improvements in therapeutic modalities for cholelithiasis and its complications are evident. The Japanese Society of Gastroenterology has revised the evidence-based clinical practice guidelines for cholelithiasis. Forty-three clinical questions, for four categories-epidemiology and pathogenesis, diagnosis, treatments, and prognosis and complications-were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases for the period between 1983 and June 2012. The guidelines were developed with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. This article preferentially describes the clinical management of cholelithiasis and its complications. Following description of the diagnosis performed stepwise through imaging modalities, treatments of cholecystolithiasis, choledocholithiasis, and hepatolithiasis are introduced along with a flowchart. Since there have been remarkable improvements in endoscopic treatments and surgical techniques, the guidelines ensure flexibility in choices according to the actual clinical environment. The revised clinical practice guidelines are appropriate for use by clinicians in their daily practice.

Post‐endoscopic retrograde cholangiopancreatography pancreatitis in patients with asymptomatic common bile duct stones

“…For asymptomatic CBD stones, endoscopic stone removal by ERCP is recommended in available guidelines because these stones are a risk factor for concurrent acute cholangitis and biliary pancreatitis. Thus, ERCP for asymptomatic CBD stones is a prophylactic treatment to prevent possible CBD stone‐related complications.…”

New surgical technique applied with urological instruments in bilobar multiple hepatolithiasis: Ultra-mini percutaneous hepatolithotomy

“…As was reported cholesterol stones can be easily, but calcium bilirubinate stones hardly fragmented. [6,8] We didn't prefer to apply ESWL in our case since we used pneumatic lithotriptor in percutaneous treatment and didn't know the stone type.…”

“…[6] While hepatectomy was the main treatment method for these patients before, it is mostly recommended for intrahepatic bile duct cancer and hepatotrophy patients together with hepatotectomy in recent years. But it is not recommended as the primary treatment method in patients who had bile duct operations.…”

“…But it is not recommended as the primary treatment method in patients who had bile duct operations. [6,7] Feng et al [1] asserted that hepatectomy was the best option for the disease recurrence in the treatment of type 2b hepatolithiasis patients.…”

“…[6] In the literature It has been applied generally for patients who had both cholelithiasis and hepatolithiasis and postoperative complications such as cholangitis and liver abscess were observed. [6] POCS was not applied in this case as the stone size was over 2 cm and the patient had had cholecystectomy.…”