title: Assessment of available evidence in the management of gallbladder and bile duct stones: a systematic review of international guidelines.
abstract: Gallstone disease is a frequent disorder in the Western world with a prevalence of 10-20%. Recommendations for the assessment and management of gallstones vary internationally. The aim of this systematic review was to assess quality of guideline recommendations for treatment of gallstones.
  
  
  
  PubMed, EMBASE and websites of relevant associations were systematically searched. Guidelines without a critical appraisal of literature were excluded. Quality of guidelines was determined using the AGREE II instrument. Recommendations without consensus or with low level of evidence were considered to define problem areas and clinical research gaps.
  
  
  
  Fourteen guidelines were included. Overall quality of guidelines was low, with a mean score of 57/100 (standard deviation 19). Five of 14 guidelines were considered suitable for use in clinical practice without modifications. Ten recommendations from all included guidelines were based on low level of evidence and subject to controversy. These included major topics, such as definition of symptomatic gallstones, indications for cholecystectomy and intraoperative cholangiography.
  
  
  
  Only five guidelines on gallstones are evidence-based and of a high quality, but even in these controversy exists on important topics. High quality evidence is needed in specific areas before an international guideline can be developed and endorsed worldwide.
authors.affiliation: Department of Surgery, Academical Medical Center, Amsterdam, The Netherlands. Electronic address: a.h.vandijk@amc.nl.
authors.forename: Aafke H
authors.initials: AH
authors.lastname: van Dijk
authors.affiliation: Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Philip R
authors.initials: PR
authors.lastname: de Reuver
authors.affiliation: Department of Surgery, Academical Medical Center, Amsterdam, The Netherlands.
authors.forename: Marc G
authors.initials: MG
authors.lastname: Besselink
authors.affiliation: Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Kees J
authors.initials: KJ
authors.lastname: van Laarhoven
authors.affiliation: Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Ewen M
authors.initials: EM
authors.lastname: Harrison
authors.affiliation: Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Wigmore
authors.affiliation: Upper GI Surgical Unit, Royal North Shore Hospital, University of Sydney, Australia.
authors.forename: Tom J
authors.initials: TJ
authors.lastname: Hugh
authors.affiliation: Department of Surgery, Academical Medical Center, Amsterdam, The Netherlands.
authors.forename: Marja A
authors.initials: MA
authors.lastname: Boermeester
mesh_terms: D002763:Cholecystectomy / Q000009:adverse effects / Q000592:standards*; D042883:Choledocholithiasis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D032921:Consensus; D019317:Evidence-Based Medicine / Q000592:standards*; D042882:Gallstones / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome