Guideline on the role of endoscopy in the evaluation and management of choledocholithiasis

“The aim of this document is to provide evidence-based recommendations for the endoscopic evaluation and treatment of choledocholithiasis based on rigorous review and synthesis of the contemporary literature, using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. The GRADE framework is a system for rating the quality of evidence and strength of recommendations that is comprehensive and transparent and has been recently adopted by the American Society for Gastrointestinal Endoscopy (ASGE). This document addresses the following 4 clinical questions:”

1. “What is the diagnostic utility of EUS versus MRCP to confirm choledocholithiasis in patients at intermediate risk of choledocholithiasis?
2. In patients with gallstone pancreatitis, what is the role of early ERCP?
3. In patients with large choledocholithiasis, is endoscopic papillary dilation after sphincterotomy favored over sphincterotomy alone?
4. What is the role of ERCP-guided intraductal therapy (EHL and laser lithotripsy) in patients with large and difficult choledocholithiasis?”

“These Guidelines use an evidence-based approach to inform a series of practical clinical questions encountered by those caring for patients with choledocholithiasis; these include the use of MRCP versus EUS for intermediate-risk patients, the role of early ERCP for gallstone pancreatitis, and the utility of papillary dilation after sphincterotomy and intraductal therapy for large and difficult concretions”

SGE Standards of Practice Committee, Buxbaum JL, et al . ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis. Gastrointest Endosc. 2019 Jun;89(6):1075-1105.e15. doi: 10.1016/j.gie.2018.10.001. Epub 2019 Apr 9. Free Full Text

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