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Endoscopic Management of Common Bile Duct Stones: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

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Endoscopic Management of Common Bile Duct Stones: European Society of Gastrointestinal Endoscopy (ESGE) Guideline Guideline Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline Authors Gianpiero Manes1, Gregorios Paspatis2, Lars Aabakken3, Andrea Anderloni4, Marianna Arvanitakis5, Philippe Ah-Soune6, Marc Barthet7,DirkDomagk8, Jean-Marc Dumonceau9, Jean-Francois Gigot10,IstvanHritz11,George Karamanolis12, Andrea Laghi13,AlbertoMariani14,KonstantinaParaskeva15, Jürgen Pohl16, Thierry Ponchon17,Fredrik Swahn18, Rinze W. F. ter Steege19, Andrea Tringali20, Antonios Vezakis21, Earl J. Williams22, Jeanin E. van Hooft23 Institutions 18 Center for Digestive Diseases, Karolinska University 1 Department of Gastroenterology, ASST Rhodense, Hospital and Division of Surgery, CLINTEC, Karolinska Rho and Garbagnate M.se Hospitals, Milan, Italy Institute, Stockholm, Sweden 2 Gastroenterology Department, Benizelion General 19 Department of Gastroenterology and Hepatology, Hospital, Heraklion, Crete, Greece University of Groningen, University Medical Center 3 GI Endoscopy, Rikshospitalet University Hospital, Groningen, Groningen, The Netherlands Hospital and Faculty of Medicine, University of Oslo, 20 Digestive Endoscopy Unit, Catholic University, Rome, Oslo, Norway Italy 4 Digestive Endoscopy Unit, Division of Gastroenterology, 21 Gastroenterology Unit, 2 Department of Surgery, Humanitas Research Hospital, Rozzano, Milan, Italy School of Medicine, National and Kapodistrian 5 Department of Gastroenterology, Hepatology and University of Athens, Athens, Greece Digestive Oncology, Erasme University Hospital 22 Department of Gastroenterology, Royal Bournemouth Université Libre de Bruxelles, Brussels, Belgium Hospital, Bournemouth, UK 6 Service d'Hépato-Gastroentérologie, Hôpital Saint- 23 Department of Gastroenterology and Hepatology, Musse, Toulon, France Amsterdam University Medical Center, University of 7 Service d'Hépato-gastroentérologie, Hôpital Nord, Amsterdam, Amsterdam, The Netherlands Marseille, France 8 Department of Medicine B, University of Münster, Bibliography Münster, Germany DOI https://doi.org/10.1055/a-0862-0346 9 Gedyt Endoscopy Center, Buenos Aires, Argentina Published online: 3.4.2019 | Endoscopy 2019; 51: 472–491 10 Department of Abdominal Surgery and © Georg Thieme Verlag KG Stuttgart · New York Transplantation, Cliniques Universitaires Saint-Luc, ISSN 0013-726X Université Catholique de Louvain, Brussels, Belgium 11 Semmelweis University, 1st Department of Surgery, Corresponding author Endoscopy Unit, Budapest, Hungary Gianpiero Manes, MD, Department of Gastroenterology, 12 Academic Department of Gastroenterology, Laiko ASST Rhodense, Rho and Garbagnate M.se Hospitals, Viale General Hospital, Medical School, National and Forlanini 95, 20024 Garbagnate M.se, Milano, Italy Kapodistrian University of Athens, Athens, Greece [email protected] 13 Pathological Sciences, Sapienza University, Rome, Italy 14 Pancreato-Biliary Endoscopy and Endosonography Appendix 1s, Tables 1s– 14s Division, Pancreas Translational & Clinical Research Online content viewable at: Center, Vita-Salute San Raffaele University, IRCCS https://doi.org/10.1055/a-0862-0346 San Raffaele Scientific Institute, Milan, Italy 15 Gastroenterology Unit, Konstantopoulio General Hospital, Athens, Greece 16 Department of Gastroenterology and Interventional Endoscopy, Klinikum Friedrichshain, Berlin, Germany 17 Department of Digestive Diseases, Hôpital Edouard Herriot, Lyon, France Manes Gianpiero et al. Endoscopic management of CBD stones … Endoscopy 2019; 51 MAIN RECOMMENDATIONS – moderate, within 48– 72 hours – ESGE recommends offering stone extraction to all patients mild, elective. with common bile duct stones, symptomatic or not, who Strong recommendation, low quality evidence. are fit enough to tolerate the intervention. ESGE recommends endoscopic placement of a temporary Strong recommendation, low quality evidence. biliary plastic stent in patients with irretrievable biliary ESGE recommends liver function tests and abdominal ultra- stones that warrant biliary drainage. sonography as the initial diagnostic steps for suspected Strong recommendation, moderate quality of evidence. common bile duct stones. Combining these tests defines ESGE recommends limited sphincterotomy combined with the probability of having common bile duct stones. endoscopic papillary large-balloon dilation as the first-line Strong recommendation, moderate quality evidence. approach to remove difficult common bile duct stones. ESGE recommends endoscopic ultrasonography or magnet- Strong recommendation, high quality evidence. ic resonance cholangiopancreatography to diagnose com- ESGE recommends the use of cholangioscopy-assisted in- mon bile duct stones in patients with persistent clinical sus- traluminal lithotripsy (electrohydraulic or laser) as an effec- picion but insufficient evidence of stones on abdominal ul- tive and safe treatment of difficult bile duct stones. trasonography. Strong recommendation, moderate quality evidence. Strong recommendation, moderate quality evidence. ESGE recommends performing a laparoscopic cholecystect- ESGE recommends the following timing for biliary drainage, omy within 2 weeks from ERCP for patients treated for cho- preferably endoscopic, in patients with acute cholangitis, ledocholithiasis to reduce the conversion rate and the risk classified according to the 2018 revision of the Tokyo of recurrent biliary events. Guidelines: Strong recommendation, moderate quality evidence. – severe, as soon as possible and within 12 hours for patients with septic shock PUBLICATION INFORMATION 2 Methods This Guideline is an official statement of the European The ESGE commissioned this Guideline (chair J.v.H.) and ap- Society of Gastrointestinal Endoscopy (ESGE). It provides pointed a guideline leader (G.M.), who invited the listed au- practical advice on how to manage common bile duct thors to participate in the project development. The key ques- stones. The Grading of Recommendations Assessment, tions were prepared by the coordinating team (G.M. and G.P.) Development, and Evaluation (GRADE) system was adop- and then approved by the other members. The coordinating ted to define the strength of recommendations and the team formed task-force subgroups, each with its own leader, quality of evidence. and divided the key topics among these task forces (Appen- dix 1s; see online-only Supplementary Material). Each task force performed a systematic literature search to prepare evidence-based and well-balanced statements on their 1Introduction assigned key questions. The coordinating team independently Gallstones are a very common problem in developed countries performed systematic literaturesearches,withPubMed/Med- [1– 3]. Most patients with gallstones remain asymptomatic line, EMBASE, the Cochrane Library, and the internet being fi- throughout their lifetime [4,5], but 10%– 25% of them may de- nally searched for papers published until April 2018.The search velop biliary pain or complications [6– 9], with an annual risk of focused on fully published randomized controlled trials (RCTs), about 2%– 3% for symptomatic disease [10] and 1%– 2% for meta-analyses, and prospective series. Retrospective analyses, major complications [11]. The development of symptomatic case series, and abstracts were also included if they addressed disease and complications is mostly related to the migration of topics not covered in the prospective studies. The literature stones into the common bile duct (CBD). Common bile duct search was restricted to papers published in English after 1990. stones (CBDSs) may be treated by endoscopic retrograde After further exploration of their content, articles that con- cholangiopancreatography (ERCP) or surgically during chole- tained relevant data were then included and summarized in the cystectomy. The aim of this evidence- and consensus-based literature tables for the key topics (Tables 1s– 14s). All select- Guideline, commissioned by the European Society of Gastro- ed articles were graded by the level of evidence and strength of intestinal Endoscopy (ESGE), is to provide practical advice on recommendation according to the GRADE system [12]. Each how to manage patients with CBDSs. It considers diagnostic task force developed a draft and proposed statements on their strategies in patients with suspected CBDSs, as well as the dif- assigned key questions, which were discussed and voted on ferent therapeutic options available for CBDSs. during plenary meetings held in February 2017 in Düsseldorf, Germany, and in October 2017 in Barcelona, Spain. In April Manes Gianpiero et al. Endoscopic management of CBD stones … Endoscopy 2019; 51 Guideline 3 General principles ABBREVIATIONS ABP acute biliary pancreatitis 3.1 Epidemiology ASGE American Society for Gastrointestinal Endoscopy Gallstones are common with a prevalence as high as 10%– 15% CBD common bile duct in developed countries [1– 3] and an overall cumulative inci- CBDS common bile duct stones dence of gallstone formation of 0.60% per year [13]. CI confidence interval According to a large Swedish registry [14], the prevalence of CT computed tomography CBDSs detected during intraoperative cholangiography (IOC) is DPOC direct peroral cholangioscopy 11.6% in patients with symptomatic gallbladder stones; other EHL electrohydraulic lithotripsy prospective studies have described a prevalence of CBDSs EPLBD endoscopic papillary large-balloon dilation detected during IOC ranging from 4.6% to 12% in Europe ERCP endoscopic retrograde cholangiopancreato- [15,16], and up to 20.9%
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