Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline

Gianpiero Manes; Gregorios Paspatis; Lars Aabakken; Andrea Anderloni; Marianna Arvanitakis; Philippe Ah-Soune; Marc Barthet; Dirk Domagk; Jean-Marc Dumonceau; Jean-Francois Gigot; Istvan Hritz; George Karamanolis; Andrea Laghi; Alberto Mariani; Konstantina Paraskeva; Jürgen Pohl; Thierry Ponchon; Fredrik Swahn; Rinze W. F. ter Steege; Andrea Tringali; Antonios Vezakis; Earl J. Williams; Jeanin E. van Hooft

doi:10.1055/a-0862-0346

Endoscopy, Table of Contents

Endoscopy 2019; 51(05): 472-491
DOI: 10.1055/a-0862-0346

Guideline

Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline

Gianpiero Manes

¹Department of Gastroenterology, ASST Rhodense, Rho and Garbagnate M.se Hospitals, Milan, Italy

,

Gregorios Paspatis

²Gastroenterology Department, Benizelion General Hospital, Heraklion, Crete, Greece

,

Lars Aabakken

³GI Endoscopy, Rikshospitalet University Hospital, Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway

,

Andrea Anderloni

⁴Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy

,

Marianna Arvanitakis

⁵Department of Gastroenterology, Hepatology and Digestive Oncology, Erasme University Hospital Université Libre de Bruxelles, Brussels, Belgium

,

Philippe Ah-Soune

⁶Service d'Hépato-Gastroentérologie, Hôpital Saint-Musse, Toulon, France

,

Marc Barthet

⁷Service d'Hépato-gastroentérologie, Hôpital Nord, Marseille, France

,

Dirk Domagk

⁸Department of Medicine B, University of Münster, Münster, Germany

,

Jean-Marc Dumonceau

⁹Gedyt Endoscopy Center, Buenos Aires, Argentina

,

Jean-Francois Gigot

¹⁰Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium

,

Istvan Hritz

¹¹Semmelweis University, 1st Department of Surgery, Endoscopy Unit, Budapest, Hungary

,

George Karamanolis

¹²Academic Department of Gastroenterology, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece

,

Andrea Laghi

¹³Pathological Sciences, Sapienza University, Rome, Italy

,

Alberto Mariani

¹⁴Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy

,

Konstantina Paraskeva

¹⁵Gastroenterology Unit, Konstantopoulio General Hospital, Athens, Greece

,

Jürgen Pohl

¹⁶Department of Gastroenterology and Interventional Endoscopy, Klinikum Friedrichshain, Berlin, Germany

,

Thierry Ponchon

¹⁷Department of Digestive Diseases, Hôpital Edouard Herriot, Lyon, France

,

Fredrik Swahn

¹⁸Center for Digestive Diseases, Karolinska University Hospital and Division of Surgery, CLINTEC, Karolinska Institute, Stockholm, Sweden

,

Rinze W. F. ter Steege

¹⁹Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

,

Andrea Tringali

²⁰Digestive Endoscopy Unit, Catholic University, Rome, Italy

,

Antonios Vezakis

²¹Gastroenterology Unit, 2 Department of Surgery, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

,

Earl J. Williams

²²Department of Gastroenterology, Royal Bournemouth Hospital, Bournemouth, UK

,

Jeanin E. van Hooft

²³Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands

› Author Affiliations

Abstract

Main Recommendations

ESGE recommends offering stone extraction to all patients with common bile duct stones, symptomatic or not, who are fit enough to tolerate the intervention.

Strong recommendation, low quality evidence.

ESGE recommends liver function tests and abdominal ultrasonography as the initial diagnostic steps for suspected common bile duct stones. Combining these tests defines the probability of having common bile duct stones.

Strong recommendation, moderate quality evidence.

ESGE recommends endoscopic ultrasonography or magnetic resonance cholangiopancreatography to diagnose common bile duct stones in patients with persistent clinical suspicion but insufficient evidence of stones on abdominal ultrasonography.

Strong recommendation, moderate quality evidence.

ESGE recommends the following timing for biliary drainage, preferably endoscopic, in patients with acute cholangitis, classified according to the 2018 revision of the Tokyo Guidelines:

– severe, as soon as possible and within 12 hours for patients with septic shock

– moderate, within 48 – 72 hours

– mild, elective.

Strong recommendation, low quality evidence.

ESGE recommends endoscopic placement of a temporary biliary plastic stent in patients with irretrievable biliary stones that warrant biliary drainage.

Strong recommendation, moderate quality of evidence.

ESGE recommends limited sphincterotomy combined with endoscopic papillary large-balloon dilation as the first-line approach to remove difficult common bile duct stones.

Strong recommendation, high quality evidence.

ESGE recommends the use of cholangioscopy-assisted intraluminal lithotripsy (electrohydraulic or laser) as an effective and safe treatment of difficult bile duct stones.

Strong recommendation, moderate quality evidence.

ESGE recommends performing a laparoscopic cholecystectomy within 2 weeks from ERCP for patients treated for choledocholithiasis to reduce the conversion rate and the risk of recurrent biliary events.

Strong recommendation, moderate quality evidence.

Full Text

References

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