Indian Survey on Management of Choledocholithiasis—Opportunities for Improvement and Future Studies
Background In clinical practice, decision about management of choledocholithiasis is driven by availability of resources and expertise, patients and healthcare professional preferences. This survey is aimed to describe the approach of physicians and surgeons for the management of choledocholithiasis...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Thieme Medical and Scientific Publishers Pvt. Ltd.
2022-12-01
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| Series: | Journal of Digestive Endoscopy |
| Subjects: | |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1758533 |
| _version_ | 1797980011069702144 |
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| author | Nitin Jagtap Sudatta Waghmare Sridhar Sundaram Rohan Khairatkar Shreeyash Modak Sundeep Lakhtakia Manu Tandan G. Venkat Rao D. Nageshwar Reddy |
| author_facet | Nitin Jagtap Sudatta Waghmare Sridhar Sundaram Rohan Khairatkar Shreeyash Modak Sundeep Lakhtakia Manu Tandan G. Venkat Rao D. Nageshwar Reddy |
| author_sort | Nitin Jagtap |
| collection | DOAJ |
| description | Background In clinical practice, decision about management of choledocholithiasis is driven by availability of resources and expertise, patients and healthcare professional preferences. This survey is aimed to describe the approach of physicians and surgeons for the management of choledocholithiasis.
Method A 36-question online survey was conducted using Google Forms on various aspects of management of choledocholithiasis.
Results The responses from 323 participants were included, of which 202 (62.54%) were physicians and 121 (37.46%) were surgeons. The proportion of responders who do not follow American or European Society of Gastrointestinal Endoscopy guidelines is associated with increasing age and experience of responders (p = 0.0001), while place of work (private vs. teaching) and broad specialty (physician vs surgeon) are not associated (p >0.05). For patients with high likelihood of choledocholithiasis, 123 (38.1%) participants prefer to do endoscopic ultrasound/magnetic resonance cholangiopancreatography (EUS/MRCP) rather than directly performing endoscopic retrograde cholangiopancreatography/intraoperative cholangiography (ERCP/IOC). For intermediate likelihood, MRCP is more commonly preferred compared with EUS, due to local availability (44%), expertise (39.6%), healthcare professionals preference (30.7%), and patients preference (17.3%). For difficult common bile duct (CBD) stones, short biliary sphincterotomy with large balloon sphincteroplasty (59.4%), followed by laparoscopic CBD exploration are commonly used approaches. Prophylactic CBD stent placement after ERCP and CBD clearance is common practice. Preoperative ERCP followed by cholecystectomy is more preferred approach than cholecystectomy and CBD exploration.
Conclusion There is considerable variability in the management of choledocholithiasis. The practices such as use of EUS/MRCP for high likelihood group, use of prophylactic CBD stent placement after ERCP and CBD clearance, and use of single stage approach especially in patient with intermediate likelihood group should be addressed in future studies. |
| first_indexed | 2024-04-11T05:47:51Z |
| format | Article |
| id | doaj.art-65319ffa6b0a47c49b00e9099dca10cf |
| institution | Directory Open Access Journal |
| issn | 0976-5042 0976-5050 |
| language | English |
| last_indexed | 2024-04-11T05:47:51Z |
| publishDate | 2022-12-01 |
| publisher | Thieme Medical and Scientific Publishers Pvt. Ltd. |
| record_format | Article |
| series | Journal of Digestive Endoscopy |
| spelling | doaj.art-65319ffa6b0a47c49b00e9099dca10cf2022-12-22T04:42:09ZengThieme Medical and Scientific Publishers Pvt. Ltd.Journal of Digestive Endoscopy0976-50420976-50502022-12-01130422422810.1055/s-0042-1758533Indian Survey on Management of Choledocholithiasis—Opportunities for Improvement and Future StudiesNitin Jagtap0Sudatta Waghmare1Sridhar Sundaram2Rohan Khairatkar3Shreeyash Modak4Sundeep Lakhtakia5Manu Tandan6G. Venkat Rao7D. Nageshwar Reddy8Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, IndiaDepartment of General Surgery, Topiwala National Medical College, Mumbai, Maharashtra, IndiaDepartment of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai, Maharashtra, IndiaDepartment of General Surgery, Dr Vaishampayan Memorial Medical College, Solapur, Maharashtra, IndiaDepartment of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, IndiaDepartment of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, IndiaDepartment of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, IndiaDepartment of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, IndiaDepartment of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, IndiaBackground In clinical practice, decision about management of choledocholithiasis is driven by availability of resources and expertise, patients and healthcare professional preferences. This survey is aimed to describe the approach of physicians and surgeons for the management of choledocholithiasis. Method A 36-question online survey was conducted using Google Forms on various aspects of management of choledocholithiasis. Results The responses from 323 participants were included, of which 202 (62.54%) were physicians and 121 (37.46%) were surgeons. The proportion of responders who do not follow American or European Society of Gastrointestinal Endoscopy guidelines is associated with increasing age and experience of responders (p = 0.0001), while place of work (private vs. teaching) and broad specialty (physician vs surgeon) are not associated (p >0.05). For patients with high likelihood of choledocholithiasis, 123 (38.1%) participants prefer to do endoscopic ultrasound/magnetic resonance cholangiopancreatography (EUS/MRCP) rather than directly performing endoscopic retrograde cholangiopancreatography/intraoperative cholangiography (ERCP/IOC). For intermediate likelihood, MRCP is more commonly preferred compared with EUS, due to local availability (44%), expertise (39.6%), healthcare professionals preference (30.7%), and patients preference (17.3%). For difficult common bile duct (CBD) stones, short biliary sphincterotomy with large balloon sphincteroplasty (59.4%), followed by laparoscopic CBD exploration are commonly used approaches. Prophylactic CBD stent placement after ERCP and CBD clearance is common practice. Preoperative ERCP followed by cholecystectomy is more preferred approach than cholecystectomy and CBD exploration. Conclusion There is considerable variability in the management of choledocholithiasis. The practices such as use of EUS/MRCP for high likelihood group, use of prophylactic CBD stent placement after ERCP and CBD clearance, and use of single stage approach especially in patient with intermediate likelihood group should be addressed in future studies.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1758533choledocholithiasisguidelinesclinical practicerisk stratificationsurvey |
| spellingShingle | Nitin Jagtap Sudatta Waghmare Sridhar Sundaram Rohan Khairatkar Shreeyash Modak Sundeep Lakhtakia Manu Tandan G. Venkat Rao D. Nageshwar Reddy Indian Survey on Management of Choledocholithiasis—Opportunities for Improvement and Future Studies Journal of Digestive Endoscopy choledocholithiasis guidelines clinical practice risk stratification survey |
| title | Indian Survey on Management of Choledocholithiasis—Opportunities for Improvement and Future Studies |
| title_full | Indian Survey on Management of Choledocholithiasis—Opportunities for Improvement and Future Studies |
| title_fullStr | Indian Survey on Management of Choledocholithiasis—Opportunities for Improvement and Future Studies |
| title_full_unstemmed | Indian Survey on Management of Choledocholithiasis—Opportunities for Improvement and Future Studies |
| title_short | Indian Survey on Management of Choledocholithiasis—Opportunities for Improvement and Future Studies |
| title_sort | indian survey on management of choledocholithiasis opportunities for improvement and future studies |
| topic | choledocholithiasis guidelines clinical practice risk stratification survey |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1758533 |
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