Evidence in cholecysto – and choledocholithiasis: A systematic review of guidelines

Aims: Cholelithiasis is a frequent disorder in the Western world with a prevalence of 10–20%. Recommendations for the assessment and management of cholecysto-choledocholithiasis vary internationally. The aim of this study was to determine the availability and the quality of guidelines for cholecysto-choledocholithiasis. Methods: Pubmed and EMBASE were systematically searched for possible guidelines. The websites of relevant associations were searched. Guidelines that did not describe a critical appraisal of the used literature were excluded. Quality of guidelines was determined using the AGREE instrument. We selected recommendations to discuss further. Only recommendations without consensus or with a low level of evidence were chosen, to accurately represent problem areas in clinical practice. Results: Ten guidelines were included in this review. Six guidelines covered all aspects of cholecysto- and choledocholithiasis. One guideline specifically comments on the prevention and treatment of bile duct injuries and four focus on the diagnosis and management of choledocholithiasis. The overall quality of the guidelines was moderate. Ten recommendations were selected to be discussed in more detail. Great controversy exists in major topics, such as the definition of symptomatic cholelithiasis, indications and contraindications for cholecystectomy, subtotal cholecystectomy and the use of intraoperative cholangiography. Conclusions: Only 10 evidence-based guidelines of moderate quality are available on cholecysto- and choledocholithiasis worldwide. Great controversy still exists in important topics. Due to the high prevalence of this disease, a high quality international guideline should be made available and endorsed by professional bodies worldwide.