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EAES rapid guideline: updated systematic review, network meta-analysis, CINeMA and GRADE assessment, and evidence-informed European recommendations on the management of common bile duct stones

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Abstract

Background

Choledocholithiasis presents in a considerable proportion of patients with gallbladder disease. There are several management options, including preoperative or intraoperative endoscopic cholangiopancreatography (ERCP), and laparoscopic common bile duct exploration (LCBDE).

Objective

To develop evidence-informed, interdisciplinary, European recommendations on the management of common bile duct stones in the context of intact gallbladder with a clinical decision to intervene to both the gallbladder and the common bile duct stones.

Methods

We updated a systematic review and network meta-analysis of LCBDE, preoperative, intraoperative, and postoperative ERCP. We formed evidence summaries using the GRADE and the CINeMA methodology, and a panel of general surgeons, gastroenterologists, and a patient representative contributed to the development of a GRADE evidence-to-decision framework to select among multiple interventions.

Results

The panel reached unanimous consensus on the first Delphi round. We suggest LCBDE over preoperative, intraoperative, or postoperative ERCP, when surgical experience and expertise are available; intraoperative ERCP over LCBDE, preoperative or postoperative ERCP, when this is logistically feasible in a given healthcare setting; and preoperative ERCP over LCBDE or postoperative ERCP, when intraoperative ERCP is not feasible and there is insufficient experience or expertise with LCBDE (weak recommendation). The evidence summaries and decision aids are available on the platform MAGICapp (https://app.magicapp.org/#/guideline/nJ5zyL).

Conclusion

We developed a rapid guideline on the management of common bile duct stones in line with latest methodological standards. It can be used by healthcare professionals and other stakeholders to inform clinical and policy decisions.

Guideline registration number

IPGRP-2022CN170.

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Disclaimer

This clinical practice guideline has been developed under the auspice of the European Association for Endoscopic Surgery (EAES). It is intended to be used primarily by health professionals (e.g., surgeons, anaesthetists, physicians) and to assist in making informed clinical decisions on diagnostic measures and therapeutic management. It is also intended to inform individual practice of allied health professionals (e.g., surgical nurses, dieticians, physical rehabilitation therapists, psychologists); to inform strategic planning and resource management by health care authorities (e.g., regional and national authorities, health care institutions, hospital administration authorities); and to inform patients wishing to obtain an overview of the condition of interest and its management. The use of recommendations contained herein must be informed by supporting evidence accompanying each recommendation and by research evidence that might not have been published by the time of writing the present document. Users must thus base their actions informed by newly published evidence at any given point in time. The information in the guideline should not be relied upon as being complete or accurate, nor should it be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. With the rapid development of scientific knowledge, new evidence may emerge between the time the guideline is developed and when it is published or read. The guideline is not continually updated and may not reflect the most recent evidence. The guideline addresses only the topics specifically identified therein and is not applicable to other interventions, diseases, or stages of diseases. This guideline does not mandate any particular course of medical care. Further, the guideline is not intended to substitute the independent professional judgment of the treating provider, as the guideline does not necessarily account for individual variation among patients. Even if evidence on a topic suggests a specific diagnostic and/or treatment action, users and especially health professionals may need to decide against the suggested or recommended action in view of circumstances related to patient values, preferences, co-morbidities and disease characteristics; available human, monetary, and material resources; and healthcare infrastructures. EAES provides this guideline on an “as is” basis, and makes no warranty, express or implied, regarding the guideline.

Funding

This project was funded by the European Association for Endoscopic Surgery. The funding bodies had no influence on the development of this rapid guideline or its protocol. There is no grant number linked to this research.

Author information

Authors and Affiliations

  1. Department of Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore, Policlinico di Milano, Milan, Italy

    Luigi Boni

  2. Faculty of Medicine, Dalhousie University, Halifax, NS, Canada

    Bright Huo

  3. Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

    Laura Alberici & Claudio Ricci

  4. Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy

    Claudio Ricci

  5. Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece

    Sofia Tsokani & Dimitris Mavridis

  6. Sorbonne Paris Cité, Faculté de Médecine, Paris Descartes University, Paris, France

    Dimitris Mavridis

  7. Pediatrics Department, and Clinical Practice Guidelines and Quality Research Unit, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia

    Yasser Sami Amer

  8. Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia

    Yasser Sami Amer

  9. Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt

    Yasser Sami Amer

  10. Guidelines International Network, Perth, Scotland Department of Surgery, York Teaching Hospital NHS Foundation Trust, York, UK

    Yasser Sami Amer

  11. Department of Surgery, York Teaching Hospital NHS Foundation Trust, York, UK

    Alexandros Andreou

  12. Department of Gastroenterology, York Teaching Hospital NHS Foundation Trust, York, UK

    Thomas Berriman

  13. Hôpital Privé Des Peupliers, Unité d’Endoscopie Interventionnelle, Ramsay Santé, Paris, France

    Gianfranco Donatelli

  14. Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy

    Gianfranco Donatelli

  15. Department of Medicine, University of Calgary, Calgary, AB, Canada

    Nauzer Forbes

  16. Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada

    Nauzer Forbes

  17. Third Department of Surgery, Evangelismos General Hospital, Athens, Greece

    Stylianos Kapiris

  18. Gastrointestinal Surgery, Yeditepe University Medical School, Istanbul, Turkey

    Cüneyt Kayaalp

  19. Department of Gastrointestinal Surgery, Helsinki University Hospital, Helsinki, Finland

    Leena Kylänpää

  20. Department of General and Digestive Surgery, Valme University Hospital, Seville, Spain

    Pablo Parra-Membrives

  21. Department of Surgery, University of Seville, Seville, Spain

    Pablo Parra-Membrives

  22. Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Netherlands

    Peter D. Siersema

  23. Patient Representative, Siloam Springs, Arkansas, USA

    George F. Black

  24. European University Cyprus, Nicosia, Cyprus

    Stavros A. Antoniou

  25. EAES Guidelines Subcommittee, Veldhoven, The Netherlands

    Stavros A. Antoniou

Authors
  1. Luigi Boni
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  2. Bright Huo
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  3. Laura Alberici
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  4. Claudio Ricci
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  5. Sofia Tsokani
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  6. Dimitris Mavridis
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  7. Yasser Sami Amer
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  8. Alexandros Andreou
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  9. Thomas Berriman
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  10. Gianfranco Donatelli
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  11. Nauzer Forbes
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  12. Stylianos Kapiris
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  13. Cüneyt Kayaalp
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  14. Leena Kylänpää
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  15. Pablo Parra-Membrives
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  16. Peter D. Siersema
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  17. George F. Black
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  18. Stavros A. Antoniou
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Corresponding author

Correspondence to Stavros A. Antoniou.

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Disclosures

Luigi Boni, Bright Huo, Laura Alberici, Claudio Ricci, Sofia Tsokani, Dimitris Mavridis, Yasser Sami Amer, Alexandros Andreou, Thomas Berriman, Gianfranco Donatelli, Nauzer Forbes, Stylianos Kapiris, Cüneyt Kayaalp, Leena Kylänpää, Pablo Parra-Membrives, Peter D. Siersema, George F. Black, Stavros A. Antoniou have no direct conflicts of interest to disclose. Indirect conflicts were documented and managed as per Guidelines International Network Standards. Detailed conflict of interest statements of all contributors can be found in https://osf.io/ncj6t/.

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Boni, L., Huo, B., Alberici, L. et al. EAES rapid guideline: updated systematic review, network meta-analysis, CINeMA and GRADE assessment, and evidence-informed European recommendations on the management of common bile duct stones. Surg Endosc 36, 7863–7876 (2022). https://doi.org/10.1007/s00464-022-09662-4

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