Endoscopy 2019; 51(05): 472-491
DOI: 10.1055/a-0862-0346
© Georg Thieme Verlag KG Stuttgart · New York

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

Gianpiero Manes
1   Department of Gastroenterology, ASST Rhodense, Rho and Garbagnate M.se Hospitals, Milan, Italy
Gregorios Paspatis
2   Gastroenterology Department, Benizelion General Hospital, Heraklion, Crete, Greece
Lars Aabakken
3   GI Endoscopy, Rikshospitalet University Hospital, Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
Andrea Anderloni
4   Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy
Marianna Arvanitakis
5   Department of Gastroenterology, Hepatology and Digestive Oncology, Erasme University Hospital Université Libre de Bruxelles, Brussels, Belgium
Philippe Ah-Soune
6   Service d'Hépato-Gastroentérologie, Hôpital Saint-Musse, Toulon, France
Marc Barthet
7   Service d'Hépato-gastroentérologie, Hôpital Nord, Marseille, France
Dirk Domagk
8   Department of Medicine B, University of Münster, Münster, Germany
Jean-Marc Dumonceau
9   Gedyt Endoscopy Center, Buenos Aires, Argentina
Jean-Francois Gigot
10   Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
Istvan Hritz
11   Semmelweis University, 1st Department of Surgery, Endoscopy Unit, Budapest, Hungary
George Karamanolis
12   Academic Department of Gastroenterology, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
Andrea Laghi
13   Pathological Sciences, Sapienza University, Rome, Italy
Alberto Mariani
14   Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
Konstantina Paraskeva
15   Gastroenterology Unit, Konstantopoulio General Hospital, Athens, Greece
Jürgen Pohl
16   Department of Gastroenterology and Interventional Endoscopy, Klinikum Friedrichshain, Berlin, Germany
Thierry Ponchon
17   Department of Digestive Diseases, Hôpital Edouard Herriot, Lyon, France
Fredrik Swahn
18   Center for Digestive Diseases, Karolinska University Hospital and Division of Surgery, CLINTEC, Karolinska Institute, Stockholm, Sweden
Rinze W. F. ter Steege
19   Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
Andrea Tringali
20   Digestive Endoscopy Unit, Catholic University, Rome, Italy
Antonios Vezakis
21   Gastroenterology Unit, 2 Department of Surgery, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
Earl J. Williams
22   Department of Gastroenterology, Royal Bournemouth Hospital, Bournemouth, UK
Jeanin E. van Hooft
23   Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
› Author Affiliations
Further Information

Publication History

Publication Date:
03 April 2019 (online)

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.

Appendix 1s, Tables 1s – 14s