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.
