National adherence to the ASGE-SAGES guidelines for managing suspected choledocholithiasis: An EAST multicenter study

Area of Science:

• Gastroenterology
• Surgical Management
• Clinical Practice Guidelines

Background:

• Guidelines for managing common bile duct (CBD) stones exist from major surgical and endoscopic societies.
• Adherence to these guidelines and their predictive accuracy for choledocholithiasis were evaluated.

Purpose of the Study:

• To assess adherence to current guidelines for suspected CBD stones.
• To evaluate the predictive capability of guidelines in identifying choledocholithiasis.

Main Methods:

• Prospective study of 844 patients undergoing cholecystectomy for choledocholithiasis or acute biliary pancreatitis (ABP) across 12 US centers.
• Patients categorized into high, intermediate, and low probability groups based on clinical predictors of CBD stones.
• Management compared against guideline recommendations.

Main Results:

• Significant guideline deviations observed: 64.3% in high-probability, 29% in intermediate, and 78.9% in low-probability groups.
• ABP and age >55 years increased odds of guideline deviation.
• CBD >6 mm and strong predictors significantly indicated choledocholithiasis.

Conclusions:

• Approximately 45% of patients managed discordantly from guidelines.
• Guidelines may require revision to improve prediction of choledocholithiasis based on clinical variables.