Each year
choledocholithiasis results in biliary obstruction,
cholangitis, and
pancreatitis in a significant number of
patients. The
primary treatment,
ERCP, is minimally invasive but associated with adverse events in 6% to 15%. This American Society for
Gastrointestinal Endoscopy (ASGE) Standard of Practice (SOP)
Guideline provides evidence-based recommendations for the endoscopic evaluation and
treatment of
choledocholithiasis. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to rigorously
review and synthesize the contemporary
literature regarding the following topics EUS versus MRCP for
diagnosis, the
role of early
ERCP in
gallstone pancreatitis, endoscopic papillary
dilation after
sphincterotomy versus
sphincterotomy alone for large
bile duct stones, and impact of
ERCP-guided intraductal
therapy for large and difficult
choledocholithiasis. Comprehensive systematic reviews were also performed to assess the following same-admission
cholecystectomy for
gallstone pancreatitis, clinical predictors of
choledocholithiasis, optimal timing of
ERCP vis-à-vis
cholecystectomy, management of
Mirizzi syndrome and hepatolithiasis, and biliary
stent therapy for
choledocholithiasis. Core clinical questions were derived using an iterative process by the ASGE SOP Committee. This body developed all recommendations founded on the certainty of the evidence, balance of
risks and harms, consideration of stakeholder preferences,
resource utilization, and
cost-
effectiveness.