Interventions and Practices Considered
Diagnosis
Liver function tests and ultrasound
Magnetic resonance cholangiopancreatography (MRCP)
Endoscopic ultrasound (EUS)
Referral for further investigation
Management
No treatment for asymptomatic gallbladder stones found in a normal gall bladder
Laparoscopic cholecystectomy for symptomatic gallbladder stones
Percutaneous cholecystostomy
Bile duct clearance
Surgically at time of laparoscopic cholecystectomy
Endoscopic retrograde cholangiopancreatography (ERCP)
Biliary stenting
Avoidance of food and drink triggers
Follow-up for new symptoms
Major Outcomes Considered
Sensitivity and specificity of diagnostic tests
Onset of new symptoms
Length of stay
Complications, such as bile duct injury
Adverse effects
Morbidity and mortality
Quality of life
Cost-effectiveness
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Methodology
Methods Used to Collect/Select the Evidence
Searches of Electronic Databases
Description of Methods Used to Collect/Select the Evidence
Note from the National Guideline Clearinghouse (NGC): This guideline was developed by an Internal Clinical Guidelines team on behalf of the National Institute for Health and Care Excellence (NICE). See the "Availability of Companion Documents" field for the full version of this guidance.
This guideline was developed in accordance with the process set out in 'The guidelines manual (2012)' (see the "Availability of Companion Documents" field). There is more information about how NICE clinical guidelines are developed on the NICE website. A booklet, 'How NICE clinical guidelines are developed: an overview for stakeholders, the public and the NHS' is available (see the "Availability of Companion Documents" field). In instances where the guidelines manual does not provide advice, additional methods are used and are described below.
A total of 8 review questions (1, 2, 3, 4a, 4b, 4c, 5, 6) were identified. A systematic literature was conducted for each review question. Identified references were reviewed against the inclusion and exclusion criteria as described in the review protocols. A literature search for health economic evidence was also completed for all review questions. Evidence reviews, search strategies and inclusion criteria are detailed in the full version of the guideline and the appendices.
Number of Source Documents
Clinical Literature Review
Review Question 1: One study met the eligibility criteria and was included.
Review Question 2: Overall, 23 studies met the eligibility criteria and were included in the review
Review Question 3: One prospective cohort study met the eligibility criteria and was included
Review Question 4a, 4b, 4c and 5: 47 references met the overall inclusion criteria.
Review Question 6: Five studies met the eligibility criteria and were included.
Health Economic Literature Review
Review Question 1: No health economic studies were found for Question 1.
Review Question 2: 2 health economic studies were found.
Review Question 3: No health economic studies were found for Question 3.
Review Question 4a, 4b, 4c and 5: 1 study was retained for Question 4b and 1 study was retained for Question 5.
Review Question 6: No health economic studies were found for Question 6.
See also Appendix E in the full guideline appendices (see "Availability of Companion Documents" field) for flow diagrams of clinical and health economic literature reviews, which detail the total number of studies included for each review question.
Interventions and Practices ConsideredDiagnosisLiver function tests and ultrasoundMagnetic resonance cholangiopancreatography (MRCP)Endoscopic ultrasound (EUS)Referral for further investigationManagementNo treatment for asymptomatic gallbladder stones found in a normal gall bladderLaparoscopic cholecystectomy for symptomatic gallbladder stonesPercutaneous cholecystostomyBile duct clearanceSurgically at time of laparoscopic cholecystectomyEndoscopic retrograde cholangiopancreatography (ERCP)Biliary stentingAvoidance of food and drink triggersFollow-up for new symptomsMajor Outcomes ConsideredSensitivity and specificity of diagnostic testsOnset of new symptomsLength of stayComplications, such as bile duct injuryAdverse effectsMorbidity and mortalityQuality of lifeCost-effectivenessBack to topMethodologyMethods Used to Collect/Select the EvidenceSearches of Electronic DatabasesDescription of Methods Used to Collect/Select the EvidenceNote from the National Guideline Clearinghouse (NGC): This guideline was developed by an Internal Clinical Guidelines team on behalf of the National Institute for Health and Care Excellence (NICE). See the "Availability of Companion Documents" field for the full version of this guidance.This guideline was developed in accordance with the process set out in 'The guidelines manual (2012)' (see the "Availability of Companion Documents" field). There is more information about how NICE clinical guidelines are developed on the NICE website. A booklet, 'How NICE clinical guidelines are developed: an overview for stakeholders, the public and the NHS' is available (see the "Availability of Companion Documents" field). In instances where the guidelines manual does not provide advice, additional methods are used and are described below.A total of 8 review questions (1, 2, 3, 4a, 4b, 4c, 5, 6) were identified. A systematic literature was conducted for each review question. Identified references were reviewed against the inclusion and exclusion criteria as described in the review protocols. A literature search for health economic evidence was also completed for all review questions. Evidence reviews, search strategies and inclusion criteria are detailed in the full version of the guideline and the appendices.Number of Source DocumentsClinical Literature ReviewReview Question 1: One study met the eligibility criteria and was included.Review Question 2: Overall, 23 studies met the eligibility criteria and were included in the reviewReview Question 3: One prospective cohort study met the eligibility criteria and was includedReview Question 4a, 4b, 4c and 5: 47 references met the overall inclusion criteria.Review Question 6: Five studies met the eligibility criteria and were included.Health Economic Literature ReviewReview Question 1: No health economic studies were found for Question 1.Review Question 2: 2 health economic studies were found.Review Question 3: No health economic studies were found for Question 3.Review Question 4a, 4b, 4c and 5: 1 study was retained for Question 4b and 1 study was retained for Question 5.Review Question 6: No health economic studies were found for Question 6.See also Appendix E in the full guideline appendices (see "Availability of Companion Documents" field) for flow diagrams of clinical and health economic literature reviews, which detail the total number of studies included for each review question.
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