National Survey Regarding the Management of Difficult Bile Duct Stones in South Korea

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Abstract

Background/Aims

This study aimed to investigate the patterns of preferred endoscopic procedure types and techniques for managing difficult common bile duct (CBD) stones in South Korea.

Methods

The Committee of Policy and Quality Management of Korean Pancreatobiliary Association (KPBA) conducted a survey containing 19 questions. Both paper and online surveys were carried out; with the paper survey being conducted during the 2019 Annual Congress of KPBA and the online survey being conducted through Google Forms from April 2020 to February 2021.

Results

The response rate was approximately 41.3% (86/208). Sixty-two (73.0%) worked at tertiary hospitals or academic medical centers, and 60 (69.7%) had more than 5 years of endoscopic retrograde cholangiopancreatography experience. The preferred size criteria for large CBD stones were 15 mm (40.6%), 20 mm (31.3%), and 30 mm (4.6%). For managing of large CBD stones, endoscopic papillary large balloon dilation after endoscopic sphincterotomy was the most preferred technique (74.4%). When performing procedures in those with bleeding diathesis, 64 (74.4%) respondents favored endoscopic papillary balloon dilation (EPBD) alone or EPBD with small endoscopic sphincterotomy. Fifty-five respondents (63.9%) preferred the double-guidewire technique when faced with difficult bile duct cannulation in patients with periampullary diverticulum. In surgically altered anatomies, cap-fitted forward viewing endoscopy (76.7%) and percutaneous transhepatic cholangioscopy (48.8%) were the preferred techniques for Billroth-II anastomosis and total gastrectomy with Roux-en-Y anastomosis, respectively.

Conclusions

Most respondents showed unifying trends for the management of difficult CBD stones. The current practice patterns could be used as basic data for clinical quality improvements in the management of difficult CBD stones.

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Most cited references 18

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ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Jean-Marc Dumonceau, Christine Kapral, Lars Aabakken … (2019)

Prophylaxis 1 ESGE recommends routine rectal administration of 100 mg of diclofenac or indomethacin immediately before endoscopic retrograde cholangiopancreatography (ERCP) in all patients without contraindications to nonsteroidal anti-inflammatory drug administration. Strong recommendation, moderate quality evidence. 2 ESGE recommends prophylactic pancreatic stenting in selected patients at high risk for post-ERCP pancreatitis (inadvertent guidewire insertion/opacification of the pancreatic duct, double-guidewire cannulation). Strong recommendation, moderate quality evidence. 3 ESGE suggests against routine endoscopic biliary sphincterotomy before the insertion of a single plastic stent or an uncovered/partially covered self-expandable metal stent for relief of biliary obstruction. Weak recommendation, moderate quality evidence. 4 ESGE recommends against the routine use of antibiotic prophylaxis before ERCP. Strong recommendation, moderate quality evidence. 5 ESGE suggests antibiotic prophylaxis before ERCP in the case of anticipated incomplete biliary drainage, for severely immunocompromised patients, and when performing cholangioscopy. Weak recommendation, moderate quality evidence. 6 ESGE suggests tests of coagulation are not routinely required prior to ERCP for patients who are not on anticoagulants and not jaundiced. Weak recommendation, low quality evidence. Treatment 7 ESGE suggests against salvage pancreatic stenting in patients with post-ERCP pancreatitis. Weak recommendation, low quality evidence. 8 ESGE suggests temporary placement of a biliary fully covered self-expandable metal stent for post-sphincterotomy bleeding refractory to standard hemostatic modalities. Weak recommendation, low quality evidence. 9 ESGE suggests to evaluate patients with post-ERCP cholangitis by abdominal ultrasonography or computed tomography (CT) scan and, in the absence of improvement with conservative therapy, to consider repeat ERCP. A bile sample should be collected for microbiological examination during repeat ERCP. Weak recommendation, low quality evidence.

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

Gianpiero Manes, Gregorios Paspatis, Lars Aabakken … (2019)

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.

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Endoscopic sphincterotomy of the ampulla of Vater.

K. Kawai, Y Akasaka, K Murakami … (1974)

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Author and article information

Journal

Journal ID (nlm-ta): Gut Liver

Journal ID (iso-abbrev): Gut Liver

Title: Gut and Liver

Publisher: Editorial Office of Gut and Liver

ISSN (Print): 1976-2283

ISSN (Electronic): 2005-1212

Publication date (Print): 15 May 2023

Publication date (Electronic): 19 July 2022

Publication date PMC-release: 19 July 2022

Volume: 17

Issue: 3

Pages: 475-481

Affiliations

[1 ]Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea

[2 ]Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea

[3 ]Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea

[4 ]Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea

[5 ]Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Korea

[6 ]Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

[7 ]Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea

[8 ]Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea

[9 ]Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea

[10 ]Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

[11 ]Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea

[12 ]Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea

[13 ]Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea

[14 ]Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea

[15 ]Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea

[16 ]Department of Internal Medicine, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea

[17 ]Department of Internal Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea

[18 ]Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea

Author notes

Corresponding Author Chang Hwan Park, ORCID https://orcid.org/0000-0002-2995-8779, E-mail E-mail: p1052ccy@ 123456hanmail.net

Author information

Yoon Suk Lee https://orcid.org/0000-0002-5835-9417

Tae Joo Jeon https://orcid.org/0000-0002-8137-1633

Woo Hyun Paik https://orcid.org/0000-0001-8708-3280

Dong-Won Ahn https://orcid.org/0000-0002-6641-2177

Kwang Hyun Chung https://orcid.org/0000-0002-8376-3921

Byoung Kwan Son https://orcid.org/0000-0002-9299-5476

Tae Jun Song https://orcid.org/0000-0002-6156-8746

Sung-Hoon Moon https://orcid.org/0000-0002-7879-3114

Eaum Seok Lee https://orcid.org/0000-0002-5689-9567

Jae Min Lee https://orcid.org/0000-0001-9553-5101

Seung Bae Yoon https://orcid.org/0000-0002-6119-7236

Chang Nyol Paik https://orcid.org/0000-0002-3470-6904

Yun Nah Lee https://orcid.org/0000-0001-5588-784X

Jin-Seok Park https://orcid.org/0000-0001-9911-8823

Dong Wook Lee https://orcid.org/0000-0002-1029-9064

Sang Wook Park https://orcid.org/0000-0002-9556-0398

Hyung Ku Chon https://orcid.org/0000-0002-6068-3849

Kwang Bum Cho https://orcid.org/0000-0003-2203-102X

Chang Hwan Park https://orcid.org/0000-0002-2995-8779

Article

Publisher ID: gnl-17-3-475

DOI: 10.5009/gnl220117

PMC ID: 10191794

PubMed ID: 35851040

SO-VID: cee6af2d-ed9d-411b-a4ec-d56c78d67f4f

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 23 March 2022

Date revision received : 14 May 2022

Date accepted : 24 May 2022

National Survey Regarding the Management of Difficult Bile Duct Stones in South Korea

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Abstract

Background/Aims

Methods

Results

Conclusions

Related collections

Karger: Gastroenterology

Most cited references 18

ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

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

Endoscopic sphincterotomy of the ampulla of Vater.

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Affiliations

Author notes

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