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Tazuma S et al, 2017: Evidence-based clinical practice guidelines for cholelithiasis 2016.

Tazuma S, Unno M, Igarashi Y, Inui K, Uchiyama K, Kai M, Tsuyuguchi T, Maguchi H, Mori T, Yamaguchi K, Ryozawa S, Nimura Y, Fujita N, Kubota K, Shoda J, Tabata M, Mine T, Sugano K, Watanabe M, Shimosegawa T.
Guidelines Committee for the Japanese Society of Gastroenterology ''Evidence-based clinical practice guidelines for cholelithiasis'', Hiroshima, Japan.
Department of General Internal Medicine, Hiroshima University Hospital, Graduate School of Medicine, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.

Abstract

Cholelithiasis is one of the commonest diseases in gastroenterology. Remarkable improvements in therapeutic modalities for cholelithiasis and its complications are evident. The Japanese Society of Gastroenterology has revised the evidence-based clinical practice guidelines for cholelithiasis. Forty-three clinical questions, for four categories-epidemiology and pathogenesis, diagnosis, treatments, and prognosis and complications-were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases for the period between 1983 and June 2012. The guidelines were developed with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. This article preferentially describes the clinical management of cholelithiasis and its complications. Following description of the diagnosis performed stepwise through imaging modalities, treatments of cholecystolithiasis, choledocholithiasis, and hepatolithiasis are introduced along with a flowchart. Since there have been remarkable improvements in endoscopic treatments and surgical techniques, the guidelines ensure flexibility in choices according to the actual clinical environment. The revised clinical practice guidelines are appropriate for use by clinicians in their daily practice.

J Gastroenterol. 2017 Mar;52(3):276-300. doi: 10.1007/s00535-016-1289-7. Review.

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Comments 1

Hans-Göran Tiselius on Friday, 11 August 2017 08:47

Handling patients with cholelithiasis is not an everyday business for urologists.
My impression has been that ever since the initial attempts to treat gallbladder stones with ESWL and apart from occasional treatments of complicated stones in the bile ducts very little was left to non-invasive stone disintegration.

It was thus with some degree of surprise to find that ESWL was presented as a treatment option for single cholesterol (ently ESWL has survived as a treatment option for uncomplicated gallbladder stones!

For stones in choledochus endoscopic techniques have been developed and the need of ESWL is today limited, but there might occasionally be fruitful with a combination of endoscopy and ESWL.

Handling patients with cholelithiasis is not an everyday business for urologists. My impression has been that ever since the initial attempts to treat gallbladder stones with ESWL and apart from occasional treatments of complicated stones in the bile ducts very little was left to non-invasive stone disintegration. It was thus with some degree of surprise to find that ESWL was presented as a treatment option for single cholesterol (ently ESWL has survived as a treatment option for uncomplicated gallbladder stones! For stones in choledochus endoscopic techniques have been developed and the need of ESWL is today limited, but there might occasionally be fruitful with a combination of endoscopy and ESWL.
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