Practice Patterns and Adherence to Society Guidelines for Suspected Choledocholithiasis: A Comparison of Academic and Community Settings From a Large Us Healthcare System

Authors

Shahrooz Rashtak
Hemant Goyal
Aswathi Chandran
Bhavtosh Dedania
Prithvi Patil
Vaibhav Wadhwa
Sushovan Guha
Tomas Davee
Srinivas Ramireddy
Nirav Thosani

Publication Date

9-1-2022

Journal

Frontiers in Medicine

Abstract

BACKGROUND: The American Society of Gastrointestinal Endoscopy (ASGE) has proposed practice guidelines for evaluating patients with suspected choledocholithiasis. This study aims to assess and compare practice patterns for following ASGE guidelines for choledocholithiasis in a large academic vs. community hospital setting.

METHODS: A total of one thousand ER indicated for choledocholithiasis were randomly selected. Patients' demographics, total bilirubin, imaging studies including magnetic resonance cholangiopancreatography (MRCP), intraoperative cholangiogram (IOC), endoscopic ultrasound (EUS), and ERCP results were retrospectively collected. Patients with prior sphincterotomy were excluded. We examined the following practice deviations from the current ASGE guidelines; (1) ERCP was potentially delayed in high probability cases while awaiting additional imaging studies, (2) ERCP was performed without additional imaging studies in cases of low/intermediate-risk, or (3) ERCP was performed in low/intermediate-risk cases when additional imaging studies were negative.

RESULTS: A total of 640 patients with native papilla who underwent ERCP were included in the final analysis. Overall, the management of 43% (275) of patients was deviated from the applicable ASGE guidelines. Academic and community provider rates of non-adherence were 32 vs. 45%, respectively (

CONCLUSION: Our study results show that providers do not adhere to ASGE practice guidelines in 43% of suspected choledocholithiasis cases. The rate of non-adherence was significantly higher in community settings. It could be due to various reasons, including lack/delays for alternate studies (i.e., MRCP, EUS), concern regarding the length of stay, patient preference, or lack of awareness/understanding of the guidelines. Increased availability of alternate imaging and educational strategies may be needed to increase the adoption of practice guidelines across academic and community settings to improve patient outcomes and save healthcare dollars.

Keywords

choledocholithiasis, practice guidelines, adherence, American Society of Gastrointestinal Endoscopy (ASGE), endoscopic retrograde cholangiopancreatography (ERCP)

Comments

PMID: 36341246