Evidence-based clinical practice guidelines for cholelithiasis 2021

Area of Science:

• Gastroenterology
• Clinical Practice Guidelines

Background:

• The Japanese Society of Gastroenterology has previously published guidelines for cholelithiasis in 2010 and 2016.
• The third edition reflects recent evidence and adheres to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.

Purpose of the Study:

• To present the updated English version of the evidence-based clinical practice guidelines for cholelithiasis.
• To provide comprehensive guidance on the diagnosis, treatment, and prognosis of gallstone disease.

Main Methods:

• Reviewed and rearranged clinical questions into background, clinical, and future research categories.
• Conducted literature searches (MEDLINE, Cochrane Library, Igaku Chuo Zasshi) from 1983-2019, supplemented by recent data.
• Evaluated evidence levels and determined recommendation strengths using the Delphi method, considering benefits, harms, patient preferences, and cost-benefit.

Main Results:

• 52 questions (29 BQ, 19 CQ, 4 FRQ) were adopted, covering epidemiology, pathogenesis, diagnosis, treatment, complications, and prognosis.
• A comprehensive flowchart for diagnosing and treating gallbladder, common bile duct, and intrahepatic stones was developed.

Conclusions:

• The revised guidelines offer contemporary clinical management strategies for cholelithiasis.
• These guidelines are expected to aid gastroenterologists and general physicians in clinical decision-making for gallstone patients.