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Updated guideline on the management of common bile duct stones (CBDS)
  1. Earl Williams1,
  2. Ian Beckingham2,
  3. Ghassan El Sayed1,
  4. Kurinchi Gurusamy3,
  5. Richard Sturgess4,
  6. George Webster5,
  7. Tudor Young6
  1. 1Bournemouth Digestive Diseases Centre, Royal Bournemouth and Christchurch NHS Hospital Trust, Bournemouth, UK
  2. 2HPB Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
  3. 3Department of Surgery, University College London Medical School, London, UK
  4. 4Aintree Digestive Diseases Unit, Aintree University Hospital Liverpool, Liverpool, UK
  5. 5Department of Hepatopancreatobiliary Medicine, University College Hospital, London, UK
  6. 6Department of Radiology, The Princess of Wales Hospital, Bridgend, UK
  1. Correspondence to Dr Earl Williams, Digestive Diseases Centre, Royal Bournemouth Hospital, Castle Lane East, Bournemouth BH7 7DW, UK; earl.williams{at}rbch.nhs.uk

Abstract

Common bile duct stones (CBDS) are estimated to be present in 10–20% of individuals with symptomatic gallstones. They can result in a number of health problems, including pain, jaundice, infection and acute pancreatitis. A variety of imaging modalities can be employed to identify the condition, while management of confirmed cases of CBDS may involve endoscopic retrograde cholangiopancreatography, surgery and radiological methods of stone extraction. Clinicians are therefore confronted with a number of potentially valid options to diagnose and treat individuals with suspected CBDS. The British Society of Gastroenterology first published a guideline on the management of CBDS in 2008. Since then a number of developments in management have occurred along with further systematic reviews of the available evidence. The following recommendations reflect these changes and provide updated guidance to healthcare professionals who are involved in the care of adult patients with suspected or proven CBDS. It is not a protocol and the recommendations contained within should not replace individual clinical judgement.

  • HEPATOBILIARY DISEASE
  • BILIARY OBSTRUCTION
  • ACUTE PANCREATITIS
  • ENDOSCOPIC RETROGRADE PANCREATOGRAPHY
  • GALLSTONE DISEASE

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Footnotes

  • Contributors The following all contributed to the manuscript as members of the guideline development group. Specific responsibilities were as follows: Peggy and Hannah Anderson. Patient representatives, approached via British Liver Trust. Reviewed draft and commented on recommendations relevant to patient experience. IB, lead author for section on surgical management of CBDS; coordinated feedback from surgical societies. GES, reviewed draft as a GI trainee and was responsible for initial literature search. KG provided critical review of evidence and methodology based on personal research and participation in other guideline development groups. Co-author for sections relating to development process for current guidelines; identifying individuals with CBDS and surgical management of CBDS. RS, lead author for sections relating to management of "difficult" ductal stones and management of CBDS in specific clinical settings. GW, lead author for section relating to endoscopic management of CBDS: EW, Chair of GDG and lead author for introductory and concluding sections, including those relating to general principles in management of CBDS and identification of individuals with CBDS. Responsible for editing contributions and document management. TY, co-author of section on identifying individuals with CBDS. Responsible for coordinating feedback from radiological societies.

  • Competing interests GW has sat on the Advisory Board for Cook Medical and Boston Scientific. He has received help from both companies in order to deliver live endoscopy courses and has had financial support to cover the costs of attending national and international meetings as a speaker. RS sits on the Advisory Board for Boston Scientific.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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