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

Luigi Boni¹, Bright Huo², Laura Alberici³, Claudio Ricci^{3

4}, Sofia Tsokani⁵, Dimitris Mavridis^{5

6}, Yasser Sami Amer^{7

8

9

10}, Alexandros Andreou¹¹, Thomas Berriman¹², Gianfranco Donatelli^{13

14}, Nauzer Forbes^{15

16}, Stylianos Kapiris¹⁷, Cüneyt Kayaalp¹⁸, Leena Kylänpää¹⁹, Pablo Parra-Membrives^{20

21}, Peter D Siersema²², George F Black²³, Stavros A Antoniou^{24

25}

Affiliations

¹ Department of Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore, Policlinico di Milano, Milan, Italy.
² Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
³ Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
⁴ Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy.
⁵ Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece.
⁶ Sorbonne Paris Cité, Faculté de Médecine, Paris Descartes University, Paris, France.
⁷ Pediatrics Department, and Clinical Practice Guidelines and Quality Research Unit, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia.
⁸ Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.
⁹ Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt.
¹⁰ Guidelines International Network, Perth, Scotland Department of Surgery, York Teaching Hospital NHS Foundation Trust, York, UK.
¹¹ Department of Surgery, York Teaching Hospital NHS Foundation Trust, York, UK.
¹² Department of Gastroenterology, York Teaching Hospital NHS Foundation Trust, York, UK.
¹³ Hôpital Privé Des Peupliers, Unité d'Endoscopie Interventionnelle, Ramsay Santé, Paris, France.
¹⁴ Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy.
¹⁵ Department of Medicine, University of Calgary, Calgary, AB, Canada.
¹⁶ Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
¹⁷ Third Department of Surgery, Evangelismos General Hospital, Athens, Greece.
¹⁸ Gastrointestinal Surgery, Yeditepe University Medical School, Istanbul, Turkey.
¹⁹ Department of Gastrointestinal Surgery, Helsinki University Hospital, Helsinki, Finland.
²⁰ Department of General and Digestive Surgery, Valme University Hospital, Seville, Spain.
²¹ Department of Surgery, University of Seville, Seville, Spain.
²² Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Netherlands.
²³ Patient Representative, Siloam Springs, Arkansas, USA.
²⁴ European University Cyprus, Nicosia, Cyprus. guidelines@eaes.eu.
²⁵ EAES Guidelines Subcommittee, Veldhoven, The Netherlands. guidelines@eaes.eu.

PMID: 36229556
DOI: 10.1007/s00464-022-09662-4

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

Luigi Boni et al. Surg Endosc. 2022 Nov.

. 2022 Nov;36(11):7863-7876.

doi: 10.1007/s00464-022-09662-4. Epub 2022 Oct 13.

Authors

Affiliations

¹ Department of Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore, Policlinico di Milano, Milan, Italy.
² Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
³ Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
⁴ Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy.
⁵ Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece.
⁶ Sorbonne Paris Cité, Faculté de Médecine, Paris Descartes University, Paris, France.
⁷ Pediatrics Department, and Clinical Practice Guidelines and Quality Research Unit, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia.
⁸ Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.
⁹ Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt.
¹⁰ Guidelines International Network, Perth, Scotland Department of Surgery, York Teaching Hospital NHS Foundation Trust, York, UK.
¹¹ Department of Surgery, York Teaching Hospital NHS Foundation Trust, York, UK.
¹² Department of Gastroenterology, York Teaching Hospital NHS Foundation Trust, York, UK.
¹³ Hôpital Privé Des Peupliers, Unité d'Endoscopie Interventionnelle, Ramsay Santé, Paris, France.
¹⁴ Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy.
¹⁵ Department of Medicine, University of Calgary, Calgary, AB, Canada.
¹⁶ Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
¹⁷ Third Department of Surgery, Evangelismos General Hospital, Athens, Greece.
¹⁸ Gastrointestinal Surgery, Yeditepe University Medical School, Istanbul, Turkey.
¹⁹ Department of Gastrointestinal Surgery, Helsinki University Hospital, Helsinki, Finland.
²⁰ Department of General and Digestive Surgery, Valme University Hospital, Seville, Spain.
²¹ Department of Surgery, University of Seville, Seville, Spain.
²² Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Netherlands.
²³ Patient Representative, Siloam Springs, Arkansas, USA.
²⁴ European University Cyprus, Nicosia, Cyprus. guidelines@eaes.eu.
²⁵ EAES Guidelines Subcommittee, Veldhoven, The Netherlands. guidelines@eaes.eu.

PMID: 36229556
DOI: 10.1007/s00464-022-09662-4

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.

Keywords: AGREE-S; Choledocholithiasis; Common bile duct stones; ERCP; Guidelines; Laparoscopic common bile duct exploration.

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Comment in

Network meta-analysis as a tool in clinical practice guidelines.
Antoniou SA, Mavridis D, Tsokani S, Morales-Conde S; EAES Guidelines Subcommittee. Antoniou SA, et al. Surg Endosc. 2023 Jan;37(1):1-4. doi: 10.1007/s00464-022-09772-z. Epub 2022 Dec 1. Surg Endosc. 2023. PMID: 36456712 Free PMC article. No abstract available.

References

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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

Affiliations

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

Authors

Affiliations

Abstract

Comment in

References

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MeSH terms

LinkOut - more resources

Full Text Sources