Greater Manchester EUR Policy Statement on: Asymptomatic Gallstones GM Ref: GM061 Version: 0.2 (21 November 2018)
|
|
- Aldous Reeves
- 5 years ago
- Views:
Transcription
1 Greater Manchester EUR Policy Statement on: Asymptomatic Gallstones GM Ref: GM061 Version: 0.2 (21 November 2018)
2 Commissioning Statement Asymptomatic Gallstones Policy Exclusions (Alternative commissioning arrangements apply) Fitness for Surgery Policy Inclusion Criteria Common bile duct (CBD) stones may present with symptoms of jaundice, cholangitis or pancreatitis, or be asymptomatic. All CBD stones should be referred for treatment because of the risk of potential severe complications. Treatment/procedures undertaken as part of an externally funded trial or as a part of locally agreed contracts / or pathways of care are excluded from this policy, i.e. locally agreed pathways take precedent over this policy (the EUR Team should be informed of any local pathway for this exclusion to take effect). NOTE: All patients should be assessed as fit for surgery before going ahead with treatment, even though funding has been approved. Surgical interventions for asymptomatic gallstones (except for those in the common bile duct) are not commissioned. Clinicians are expected to diagnose, refer and manage patients in line with NICE CG188: Gallstone disease: diagnosis and management (see Appendix 1 for a summary). Funding Mechanism Clinicians can submit an individual funding request outside of this guidance if they feel there is a good case for clinical exceptionality. Requests must be submitted with all relevant supporting evidence. Clinical Exceptionality Clinicians can submit an Individual Funding Request (IFR) outside of this guidance if they feel there is a good case for exceptionality. Exceptionality means a person to which the general rule is not applicable. Greater Manchester sets out the following guidance in terms of determining exceptionality; however the over-riding question which the IFR process must answer is whether each patient applying for exceptional funding has demonstrated that his/her circumstances are exceptional. A patient may be able to demonstrate exceptionality by showing that s/he is: Significantly different to the general population of patients with the condition in question. and as a result of that difference They are likely to gain significantly more benefit from the intervention than might be expected from the average patient with the condition. GM Gallstones Policy v0.2 DRAFT Page 2 of 13
3 Contents Commissioning Statement... 2 Policy Statement... 4 Equality & Equity Statement... 4 Governance Arrangements... 4 Aims and Objectives... 4 Rationale behind the policy statement... 5 Treatment / Procedure... 5 Epidemiology and Need... 5 Adherence to NICE Guidance... 5 Audit Requirements... 5 Date of Review... 5 Glossary... 6 References... 6 Governance Approvals... 6 Appendix 1 Evidence Review... 8 Appendix 2 Diagnostic and Procedure Codes Appendix 3 Version History GM Gallstones Policy v0.2 DRAFT Page 3 of 13
4 Policy Statement Greater Manchester Health and Care Commissioning (GMHCC) Effective Use of Resources (EUR) Policy Team, in conjunction with the GM EUR Steering Group, have developed this policy on behalf of Clinical Commissioning Groups (CCGs) within Greater Manchester, who will commission treatments/procedures in accordance with the criteria outlined in this document. In creating this policy GMHCC/GM EUR Steering Group reviewed asymptomatic gallstones and the options for its treatment. It has considered the place of this treatment in current clinical practice, whether scientific research has shown the treatment to be of benefit to patients, (including how any benefit is balanced against possible risks) and whether its use represents the best use of NHS resources. This policy document outlines the arrangements for funding of treatment for asymptomatic gallstones the population of Greater Manchester. This policy follows the principles set out in the ethical framework that govern the commissioning of NHS healthcare and those policies dealing with the approach to experimental treatments and processes for the management of individual funding requests (IFR). Equality & Equity Statement GMHCC/CCGs have a duty to have regard to the need to reduce health inequalities in access to health services and health outcomes achieved, as enshrined in the Health and Social Care Act GMHCC/CCGs are committed to ensuring equality of access and non-discrimination, irrespective of age, gender, disability (including learning disability), gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, gender or sexual orientation. In carrying out its functions, GMHCC/CCGs will have due regard to the different needs of protected characteristic groups, in line with the Equality Act This document is compliant with the NHS Constitution and the Human Rights Act This applies to all activities for which they are responsible, including policy development, review and implementation. In developing policy the GMHCC EUR Policy Team will ensure that equity is considered as well as equality. Equity means providing greater resource for those groups of the population with greater needs without disadvantage to any vulnerable group. The Equality Act 2010 states that we must treat disabled people as more equal than any other protected characteristic group. This is because their starting point is considered to be further back than any other group. This will be reflected in GMHCC evidencing taking due regard for fair access to healthcare information, services and premises. An Equality Analysis has been carried out on the policy. For more information about the Equality Analysis, please contact policyfeedback.gmscu@nhs.net. Governance Arrangements Greater Manchester EUR policy statements will be ratified by the Greater Manchester Joint Commissioning Board (GMJCB) prior to formal ratification through CCG Governing Bodies. Further details of the governance arrangements can be found in the GM EUR Operational Policy. Aims and Objectives This policy document aims to ensure equity, consistency and clarity in the commissioning of treatments/procedures by CCGs in Greater Manchester by: reducing the variation in access to treatments/procedures. GM Gallstones Policy v0.2 DRAFT Page 4 of 13
5 ensuring that treatments/procedures are commissioned where there is acceptable evidence of clinical benefit and cost-effectiveness. reducing unacceptable variation in the commissioning of treatments/procedures across Greater Manchester. promoting the cost-effective use of healthcare resources. Rationale behind the policy statement Asymptomatic gallstones are very common. No treatment is required unless symptoms or signs develop such as abdominal pains, abdominal discomfort, or jaundice. Any treatment aimed at preventing future complications is not recommended (such as prophylactic cholecystectomy) as the risk of complications from surgical treatment outweighs the potential risk of developing complications from the stones 4. Treatment / Procedure Gallstones are small stones, usually made of cholesterol, that form in the gallbladder. In most cases, they don't cause any symptoms and don't need to be treated. Surgery may remove the entire gallbladder (cholecystectomy), or just the stones from bile ducts. Techniques to remove the gallbladder include: laparoscopic cholecystectomy 'keyhole' surgery. The surgeon makes small incisions (cuts) through the skin, allowing access for a range of instruments, the surgeon then removes the gallbladder through one of the incisions. Open surgery (laparotomy) the surgeon reaches the gallbladder through a wider abdominal incision. Epidemiology and Need In the UK around 10-15% of the adult population have gallstones 3. The majority of people with gallbladder stones remain asymptomatic and require no treatment. The definitive treatment of symptomatic gallbladder stones is surgical removal of the gallbladder. Adherence to NICE Guidance This policy adheres to NICE CG188: Gallstone disease: diagnosis and management. Audit Requirements There is currently no national database. Service providers will be expected to collect and provide audit data on request. Date of Review One year from the date of approval by the governance process and thereafter at a date agreed by the Greater Manchester EUR Steering Group, unless new evidence or technology is available sooner. The evidence base for the policy will be reviewed and any recommendations within the policy will be checked against any new evidence. Any operational issues will also be considered at this time. All available additional data on outcomes will be included in the review and the policy updated accordingly. The policy will be continued, amended or withdrawn subject to the outcome of that review. GM Gallstones Policy v0.2 DRAFT Page 5 of 13
6 Glossary Term Asymptomatic gallstones Cholelithiasis Common bile duct Meaning the presence of gallstones detected incidentally in patients who do not have any abdominal symptoms or have symptoms that are not thought to be due to gallstones. Diagnosis is made during routine ultrasound for other abdominal conditions or, occasionally, by palpation of the gall bladder at operation. This definition implies that we know which symptoms are specific to gallstones. Gallstones The common bile duct is a small, tube-like structure formed where the common hepatic duct and the cystic duct join. Its physiological role is to carry bile from the gallbladder and empty it into the upper part of the small intestine (the duodenum). Cystic duct Hepatic Laparoscopic cholecystectomy Laparotomy The cystic duct transfers bile between the gallbladder and common and hepatic bile ducts. Pertaining to the liver. The surgeon makes small incisions (cuts) through the skin, allowing access for a range of instruments to remove the gall bladder. A surgical incision into the abdominal cavity, for diagnosis or in preparation for major surgery. References 1. Greater Manchester Effective Use of Resources Operational Policy 2. World Gastroenterology Organisation Practice Guideline: Asymptomatic Gallstone Disease 3. Royal College of Surgeons Commissioning guide 2013 Gallstone Disease 4. NICE Clinical Knowledge Summary- Asymptomatic Gallstones Governance Approvals Name Date Approved Greater Manchester Effective Use of Resources Steering Group Greater Manchester Chief Finance Officers / Greater Manchester Directors of Commissioning GM Gallstones Policy v0.2 DRAFT Page 6 of 13
7 Greater Manchester Joint Commissioning Board Bury Clinical Commissioning Group Bolton Clinical Commissioning Group Heywood, Middleton & Rochdale Clinical Commissioning Group Manchester Clinical Commissioning Group Oldham Clinical Commissioning Group Salford Clinical Commissioning Group Stockport Clinical Commissioning Group Tameside & Glossop Clinical Commissioning Group Trafford Clinical Commissioning Group Wigan Borough Clinical Commissioning Group GM Gallstones Policy v0.2 DRAFT Page 7 of 13
8 Appendix 1 Evidence Review Asymptomatic Gallstones GM061 Search Strategy The following databases are routinely searched: NICE Clinical Guidance and full website search; NHS Evidence and NICE CKS; SIGN; Cochrane; York; and the relevant Royal College and any other relevant bespoke sites. A Medline / Open Athens search is undertaken where indicated and a general google search for key terms may also be undertaken. The results from these and any other sources are included in the table below. If nothing is found on a particular website it will not appear in the table below: Database Result NICE evidence NICE CKS: Gallstones, Last revised: February 2015 NICE guidance NICE CG188: Gallstone disease: diagnosis and management, Published: 29 October 2014 NICE Quality Standard (QS104): Gallstone disease NICE Quality standard, Published: 3 December 2015 (not cited here) RCS website RCS Commissioning Guide 2013: Gallstone disease Summary of the evidence The evidence-based consensus in all of the above guidelines is that the risks of surgery are not outweighed by the benefits for the removal of asymptomatic gallstones with the exception of those found in the common bile duct and, as such, it should not be considered in the majority of cases. The evidence Levels of evidence Level 1 Level 2 Level 3 Level 4 Level 5 Meta-analyses, systematic reviews of randomised controlled trials Randomised controlled trials Case-control or cohort studies Non-analytic studies e.g. case reports, case series Expert opinion 1. LEVEL 1: NICE CLINICAL GUIDELINES NICE CG188: Gallstone disease: diagnosis and management, Published: 29 October Recommendations 1.1 Diagnosing gallstone disease Offer liver function tests and ultrasound to people with suspected gallstone disease, and to people with abdominal or gastrointestinal symptoms that have been unresponsive to previous management Consider magnetic resonance cholangiopancreatography (MRCP) if ultrasound has not detected common bile duct stones but the: bile duct is dilated and/or GM Gallstones Policy v0.2 DRAFT Page 8 of 13
9 liver function test results are abnormal Consider endoscopic ultrasound (EUS) if MRCP does not allow a diagnosis to be made Refer people for further investigations if conditions other than gallstone disease are suspected. 1.2 Managing gallbladder stones Reassure people with asymptomatic gallbladder stones found in a normal gallbladder and normal biliary tree that they do not need treatment unless they develop symptoms Offer laparoscopic cholecystectomy to people diagnosed with symptomatic gallbladder stones Offer day-case laparoscopic cholecystectomy for people having it as an elective planned procedure, unless their circumstances or clinical condition make an inpatient stay necessary Offer early laparoscopic cholecystectomy (to be carried out within 1 week of diagnosis) to people with acute cholecystitis Offer percutaneous cholecystostomy to manage gallbladder empyema when: surgery is contraindicated at presentation and conservative management is unsuccessful Reconsider laparoscopic cholecystectomy for people who have had percutaneous cholecystostomy once they are well enough for surgery. 1.3 Managing common bile duct stones Offer bile duct clearance and laparoscopic cholecystectomy to people with symptomatic or asymptomatic common bile duct stones Clear the bile duct: surgically at the time of laparoscopic cholecystectomy or with endoscopic retrograde cholangiopancreatography (ERCP) before or at the time of laparoscopic cholecystectomy If the bile duct cannot be cleared with ERCP, use biliary stenting to achieve biliary drainage only as a temporary measure until definitive endoscopic or surgical clearance Use the lowest-cost option suitable for the clinical situation when choosing between day-case and inpatient procedures for elective ERCP. Patient, family member and carer information Advise people to avoid food and drink that triggers their symptoms until they have their gallbladder or gallstones removed Advise people that they should not need to avoid food and drink that triggered their symptoms after they have their gallbladder or gallstones removed Advise people to seek further advice from their GP if eating or drinking triggers existing symptoms or causes new symptoms to develop after they have recovered from having their gallbladder or gallstones removed. 2. LEVEL 1: RCS COMMISSIONING GUIDE RCS Commissioning Guide 2013: Gallstone disease 1 High value care pathway for gallstone disease 1.1 Primary care Non-referral Patients with an incidental finding of stones in an otherwise normal gallbladder require no further investigation or referral. Primary care management Most patients with symptomatic gallstones present with a self-limiting attack of pain that lasts for hours only. This can often be controlled successfully in primary care with appropriate analgesia, avoiding the requirement for emergency admission. When pain cannot be managed or if the patient is otherwise unwell (e.g. sepsis), he or she should be referred to hospital as an emergency. GM Gallstones Policy v0.2 DRAFT Page 9 of 13
10 Further episodes of biliary pain can be prevented in around 30% of patients by adopting a low fat diet. Fat in the stomach releases cholecystokinin, which precipitates gallbladder contraction and might result in biliary pain. Patients with suspicion of acute cholecystitis, cholangitis or acute pancreatitis should be referred to hospital as an emergency. There is no evidence to support the use of hyoscine or proton pump inhibitors in the management of gallbladder symptoms. Antibiotics should be reserved for patients with signs of sepsis. There is no evidence of benefit from the use of non-surgical treatments in the definitive management of gallbladder stones (e.g. gallstone dissolution therapies, ursodeoxycholic acid or extracorporeal lithotripsy). Best practice referral guidelines Epigastric or right upper quadrant pain, frequently radiating to the back, lasting for several minutes to hours (often occurring at night) suggests symptomatic gallstones. These patients should have liver function tests checked and be referred for ultrasonography. Confirmation of symptomatic gallstones should result in a discussion of the merits of a referral to a surgical service regularly performing cholecystectomies. Following treatment for CBD stones with endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy, removal of the gallbladder should be considered in all patients. However, in patients with significant co-morbidities, the risks of surgery may outweigh the benefits. Patients with known gallstones with a history of acute pancreatitis should be referred for a cholecystectomy to a surgical service regularly performing the procedure. Patients with known gallstones and jaundice or clinical suspicion of biliary obstruction (e.g. significantly abnormal liver function tests) should be referred urgently to a gastroenterology or surgical service with expertise in managing biliary diseases. 1.2 Secondary care In patients with symptomatic gallstones, the decision to operate is made by the patient with guidance from the surgeon. This will include assessment of the risk of recurrent symptoms and complications of the gallstones (50% risk per annum of further episode of biliary colic and 1 2% risk per annum of development of serious complications), and the risks and complication rates of surgery in relation to the individual patient s co-morbidities and preference. Patients with acute gallstone pancreatitis should undergo definitive treatment (usually cholecystectomy although an endoscopic sphincterotomy may be appropriate in frail patients) within two weeks of recovery from the incident episode, as described in the UK guidelines for the management of acute pancreatitis. If the cause of abnormal liver function tests +/- dilated bile ducts is unclear on initial imaging, further investigation is required. This will usually be with preoperative magnetic resonance cholangiopancreatography or endoscopic ultrasonography. ERCP should be reserved for therapy, not as a diagnostic test for bile duct stones. Preoperative on-table cholangiography is an alternative strategy in units that offer laparoscopic bile duct exploration. Patients with symptomatic CBD stones should undergo CBD stone extraction by ERCP or surgical bile duct exploration (laparoscopic or open). Patients with asymptomatic gallstones should also be considered for stone extraction. The laparoscopic approach to cholecystectomy should be considered the standard for the majority of patients. Secondary providers offering cholecystectomy must be able to offer intraoperative on-table cholangiography and have arrangements in place for urgent access to ERCP and interventional radiology for the management of postoperative complications. Patients who have a suspected bile duct injury should be referred to their regional tertiary hepatopancreatobiliary service. GM Gallstones Policy v0.2 DRAFT Page 10 of 13
11 3. LEVEL N/A: NICE CLINICAL KNOWLEDGE SUMMARY NICE CKS: Gallstones, Last revised: February 2015 Scenario: Asymptomatic gallstones Scenario: Management of people with asymptomatic gallstones Age from 18 years onwards How do I manage a person with asymptomatic gallstones? For a person with asymptomatic gallstones found in a normal gallbladder, and with a normal biliary tree, explain to the person that: o Asymptomatic gallstones are very common. o No treatment is required unless symptoms or signs develop such as abdominal pains, abdominal discomfort, or jaundice, when they should seek medical advice. o Any treatment aimed at preventing future complications is also not recommended (such as prophylactic cholecystectomy) as the risk of complications from surgical treatment outweighs the potential risk of developing complications from the stones. For a person with asymptomatic gallstones found in the common bile duct, explain to the person that: o Although they are asymptomatic, there is a significant risk of developing serious complications such as cholangitis or pancreatitis. o Therefore, they should be managed the same as a person with Symptomatic gallstones with common bile duct stones. Basis for recommendation No treatment for asymptomatic gallstones in a normal gallbladder with a normal biliary tree The recommendation that treatment is not required is based on the National Institute for Health and Care Excellence (NICE) guideline Gallstone disease: Diagnosis and management of cholelithiasis, cholecystitis and choledocholithiasis[nice, 2014]. This is consistent with the Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland Commissioning guide: gallstone disease which states that 'patients with an incidental finding of stones in an otherwise normal gallbladder require no further investigation or referral' [Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland, 2013]. Treatment for asymptomatic gallstones found in the common bile duct The recommendation that treatment is required is based on the NICE guideline Gallstone disease: Diagnosis and management of cholelithiasis, cholecystitis and choledocholithiasis [NICE, 2014]. This is consistent with the Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland Commissioning guide: gallstone disease which states that 'all common bile duct stones should be referred for treatment because of the risk of potential severe complications' [Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland, 2013]. GM Gallstones Policy v0.2 DRAFT Page 11 of 13
12 Appendix 2 Diagnostic and Procedure Codes Asymptomatic Gallstones GM061 (All codes have been verified by Mersey Internal Audit s Clinical Coding Academy) [To add when final policy approved] GM Gallstones Policy v0.2 DRAFT Page 12 of 13
13 Appendix 3 Version History Asymptomatic Gallstones GM061 The latest version of this policy can be found here [To add link when final policy approved] Version Date Summary of Changes /11/2018 Initial draft /11/2018 Policy approved at GM EUR Steering Group to progress to Clinical Engagement with no amendments needing to be made. GM Gallstones Policy v0.2 DRAFT Page 13 of 13
Policy Statement. Title/Topic: Hyaluronic Acid Injections for Osteoarthritis Date: April 2014 Reference: GM037
Policy Statement Title/Topic: Hyaluronic Acid Injections for Osteoarthritis Date: April 2014 Reference: GM037 VERSION CONTROL Version Date Details Page number 0.1 09/09/2013 Initial draft N/A 0.2 19/09/2013
More informationGreater Manchester EUR Policy Statement
Greater Manchester EUR Policy Statement Title/Topic: Hyaluronic Acid Injections for Osteoarthritis Date: June 2014 Last Reviewed: May 2015 Reference: GM037 VERSION CONTROL Version Date Details Page number
More informationGreater Manchester EUR Policy Statement on: Invasive Treatments for Snoring GM Ref: GM068 Version: 2.1 (6 June 2018)
Greater Manchester EUR Policy Statement on: Invasive Treatments for Snoring GM Ref: GM068 Version: 2.1 (6 June 2018) Commissioning Statement Invasive Treatments for Snoring Policy Exclusions (Alternative
More informationCommissioning Policy Individual Funding Request
Commissioning Policy Individual Funding Request Laparoscopic Cholecystectomy for Gallstones in Adults Criteria Based Access Policy Date Adopted: 22 December 2017 Version: 1718.3.01 Individual Funding Request
More informationQuality & Safety Committee 17 th August 2017 Agenda item: 6.2
SUMMARY REPORT ABM University Health Board Quality & Safety Committee 17 th August 2017 Agenda item: 6.2 Subject Improvements in the management of gallstone disease Prepared by Approved & presented by:
More informationSurveillance proposal consultation document
Surveillance proposal consultation document 2018 surveillance of Gallstone disease: diagnosis and management (NICE guideline CG188) Proposed surveillance decision We propose to not update the NICE guideline
More informationGreater Manchester EUR Policy Statement. Title/Topic: Tonsillectomy Date: April 2014 Last reviewed: May 2015 Reference: GM028
Greater Manchester EUR Policy Statement Title/Topic: Tonsillectomy Date: April 2014 Last reviewed: May 2015 Reference: GM028 VERSION CONTROL Version Date Details Page number 0.1 09/09/2013 Initial draft
More informationGreater Manchester EUR Policy Statement. Title/Topic: Surgical Revision of Scarring Date: June 2015 Reference: GM066
Greater Manchester EUR Policy Statement Title/Topic: Surgical Revision of Scarring Date: June 2015 Reference: GM066 VERSION CONTROL Version Date Details Page number 0.1 02/09/2014 Initial draft N/A 0.2
More informationAppendix A: Summary of evidence from surveillance
Appendix A: Summary of evidence from surveillance 2018 surveillance of Gallstone disease: diagnosis and management (2014) NICE guideline CG188 Summary of evidence from surveillance Studies identified in
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE
Appendix B: Scope NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE Post publication note: The title of this guideline changed during development. This scope was published before the guideline
More informationManagement of GALLSTONE Disease and GALLBLADDER Pathology December 2017
Commissioning Policy Management of GALLSTONE Disease and GALLBLADDER Pathology December 2017 This policy applies to patients for whom the following Clinical Commissioning Groups are responsible: NHS South
More informationCLINICAL GUIDELINE FOR MANAGEMENT OF GALLSTONES PATHOLOGY IN ADULTS
CLINICAL GUIDELINE FOR MANAGEMENT OF GALLSTONES PATHOLOGY IN ADULTS 1. Aim/Purpose of this Guideline This guideline is for the management of gallstones pathology in adults. It has been benchmarked against
More informationREFERRAL GUIDELINES: GALLSTONES
REFERRAL GUIDELINES: GALLSTONES Document Purpose To ensure patients with gallstones disease are managed appropriately in primary/ secondary care Oxford Radcliffe Hospital Surgical Department Surgical Registrar
More informationAppendix J: Full Health Economics Report
1 Appendix J: Full Health Economics Report 1.1 Contents Appendix J: Full Health Economics Report... 1 1.1 Contents... 1 1. Introduction... 1. Decision Problem... 8 1. Systematic Review of Existing Literature...
More informationFigure 2: Post-cholecystectomy biliary-like pain
Figure 2: Post-cholecystectomy biliary-like pain 1 patient with recurrent episodes of pain (not daily), in the epigastrium/right upper quadrant, lasting >30 mins, building to a steady level, interrupting
More informationGreater Manchester EUR Policy Statement on: Body Contouring GM Ref: GM011 & GM019 Version: 2.4 (6 June 2018)
Greater Manchester EUR Policy Statement on: Body Contouring GM Ref: GM011 & GM019 Version: 2.4 (6 June 2018) Commissioning Statement Body Contouring Policy Exclusions (Alternative commissioning arrangements
More informationGall bladder cancer. Information for patients Hepatobiliary
Gall bladder cancer Information for patients Hepatobiliary page 2 of 12 Who will provide my care? You will be cared for by a number of professionals who work together. These professionals will be specialist
More informationInsert heading depending. cover options once. other cover options once you have chosen one. 20pt. Ref: N-SC/031
Insert heading depending Insert Interim Insert heading Clinical Commissioning depending on line on on Policy: line length; length; please please delete delete on line line Spinal length; Surgery please
More informationGreater Manchester EUR Policy Statement on: Bunion (Hallux Valgus) Surgery GM Ref: GM052 Version: 3.0 (17 Jan 2018)
Greater Manchester EUR Policy Statement on: Bunion (Hallux Valgus) Surgery GM Ref: GM052 Version: 3.0 (17 Jan 2018) Commissioning Statement Bunion (Hallux Valgus) Surgery Policy Exclusions Hallux Rigidus
More informationInternational Journal of Health Sciences and Research ISSN:
International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Original Research Article Comparative Study between Laparoscopic and Open Cholecystectomy for Dr. B. Hemasankararao 1,
More informationEndoscopic Retrograde Pancreatography and Laparoscopic Cholecystectomy. TEAM 1 Janix M. De Guzman, MD Presentor
Endoscopic Retrograde Pancreatography and Laparoscopic Cholecystectomy TEAM 1 Janix M. De Guzman, MD Presentor Premise 40F Jaundice Abdominal pain US finding of gallstones with apparently normal common
More informationGallstones Information Leaflet THE DIGESTIVE SYSTEM. Gutscharity.org.uk
THE DIGESTIVE SYSTEM http://healthfavo.com/digestive-system-for-kids.html This factsheet is about gallstones Gall is an old-fashioned word for bile, a liquid made in the liver and stored in the gall bladder
More informationMagnetic Resonance Cholangiopancreatography (MRCP) in a District General Hospital
Magnetic Resonance Cholangiopancreatography (MRCP) in a District General Hospital Poster No.: C-1790 Congress: ECR 2012 Type: Authors: Scientific Exhibit J. A. Maguire 1, H. Kasem 2, M. Akhtar 2, M. Strauss
More informationGreater Manchester EUR Policy Statement on: Surgical Correction of Trigger Finger GM Ref: GM038 Version: 1.1 (6 June 2018)
Greater Manchester EUR Policy Statement on: Surgical Correction of Trigger Finger GM Ref: GM038 Version: 1.1 (6 June 2018) Commissioning Statement Surgical Correction of Trigger Finger Policy Exclusions
More informationGoverning Body (Public) Meeting
ENCLOSURE: T Agenda Item: 86/13 Governing Body (Public) Meeting DATE: 25 July 2013 Title Recommended action for the Governing Body Expanding the Treatment Access Policy for Bexley That the Governing Body:
More informationType of intervention Treatment. Economic study type Cost-effectiveness analysis.
Preoperative endoscopic sphincterotomy versus laparoendoscopic rendezvous in patients with gallbladder and bile duct stones Morino M, Baracchi F, Miglietta C, Furlan N, Ragona R, Garbarini A Record Status
More informationPrimary Sclerosing Cholangitis and Cholestatic liver diseases. Ahsan M Bhatti MD, FACP Bhatti Gastroenterology Consultants
Primary Sclerosing Cholangitis and Cholestatic liver diseases Ahsan M Bhatti MD, FACP Bhatti Gastroenterology Consultants I have nothing to disclose Educational Objectives What is PSC? Understand the cholestatic
More informationBiliary tree dilation - and now what?
Biliary tree dilation - and now what? Poster No.: C-1767 Congress: ECR 2012 Type: Educational Exhibit Authors: I. Ferreira, A. B. Ramos, S. Magalhães, M. Certo; Porto/PT Keywords: Pathology, Diagnostic
More informationSetting The study setting was hospital. The economic analysis was carried out in California, USA.
Preoperative versus postoperative endoscopic retrograde cholangiopancreatography in mild to moderate gallstone pancreatitis: a prospective randomized trial Chang L, Lo S, Stabile B E, Lewis R J, Toosie
More informationGreater Manchester EUR Policy Statement on: Labiaplasty GM Ref: GM027 Version: 3.0 (15 Nov 2017)
Greater Manchester EUR Policy Statement on: Labiaplasty GM Ref: GM027 Version: 3.0 (15 Nov 2017) Commissioning Statement Labiaplasty Policy Exclusions Labiaplasty carried out as the result of obstetric
More informationPresence of choledocholithiasis in patients undergoing cholecystectomy for mild biliary pancreatitis
Original Article Presence of choledocholithiasis in patients undergoing cholecystectomy for mild biliary pancreatitis Pradhan S 1, Shah S 2, Maharjan S 2, Shah JN 3 1 2 2 3 Professor, Patan hospital Correspondence:
More informationManagement of Gallbladder Disease
Management of Gallbladder Disease Steven B. Johnson, MD, FACS, FCCM Professor and Chairman, Department of Surgery Program Director, Phoenix Integrated Surgical Residency University of Arizona College of
More informationSpecialised Services Commissioning Policy. CP29: Bariatric Surgery
Specialised Services Commissioning Policy CP29: Bariatric Surgery Document Author: Specialist Planner, Cardiothoracic Executive Lead: Director of Planning Approved by: Management Group Issue Date: 12 June
More informationInsulin Pumps and Glucose Monitors in Adults Policy
Insulin Pumps and Glucose Monitors in Adults Policy Version: 2016-19 Ratified by: NHS Leeds West CCG Assurance Committee on; 16 November 2016 NHS Leeds North CCG Governance on Performance and Risk Committee
More informationInsert heading depending line on length; please delete delete. length; please delete other cover options once
Insert heading depending Insert on Interim Insert heading line length; Clinical please Commissioning depending on line on length; please delete delete other Policy: on line line cover Circumcision length;
More informationWhat Are Gallstones? GALLSTONES. Gallstones are pieces of hard, solid matter that form over time in. the gallbladder of some people.
What Are Gallstones? Gallstones are pieces of hard, solid matter that form over time in the gallbladder of some people. The gallbladder sits under the liver and stores bile (a key digestive juice ). Gallstones
More informationEvidence-based guidelines for diagnosis of common bile duct stones Vanja Giljaca University Hospital Center Rijeka Department of Gastroenterology
Evidencebased guidelines for diagnosis of common bile duct stones Vanja Giljaca University Hospital Center Rijeka Department of Gastroenterology Trusted evidence. Informed decisions. Better health. Outline
More informationDISCLAIMER. No Conflict of Interest
DISCLAIMER No Conflict of Interest EXCLAIMER No Interest in Conflict GALLSTONES FAQs and FACTS John Dunn, FRACS Laparoscopy Auckland YOU GOTTA KNOW THIS STUFF HOW DO THEY FORM? Gallbladder Lithogenic
More informationGreater Manchester EUR Policy Statement on: Cataract Surgery GM Ref: GM026 Version: 3.1 (15 Nov 2017)
Greater Manchester EUR Policy Statement on: Cataract Surgery GM Ref: GM026 Version: 3.1 (15 Nov 2017) Commissioning Statement Cataract Surgery Policy Exclusions Juvenile cataract, lens-induced disease
More informationCommissioning Policy Individual Funding Request
Commissioning Policy Individual Funding Request Hernia Repair in Adults Criteria Based Access Policy Date Adopted: 22 December 2017 Version: 1718.3.01 Individual Funding Request Team - A partnership between
More informationP R E S E N T S Dr. Mufa T. Ghadiali is skilled in all aspects of General Surgery. His General Surgery Services include: General Surgery Advanced Laparoscopic Surgery Surgical Oncology Gastrointestinal
More informationGreater Manchester EUR Policy Statement. Title/Topic: Cataract Surgery Reference: GM026 Date: September 2014 Last Reviewed: September 2015
Greater Manchester EUR Policy Statement Title/Topic: Cataract Surgery Reference: GM026 Date: September 2014 Last Reviewed: September 2015 VERSION CONTROL Version Date Details Page number 0.1 07/01/2014
More informationWhat can you expect after your ERCP?
ERCP Explained and respond to bed rest, pain relief and fasting to rest the gut with the patient needing to stay in hospital for only a few days. Some patients develop severe pancreatitis and may require
More informationPancreatic Cancer (1 of 5)
i If you need your information in another language or medium (audio, large print, etc) please contact Customer Care on 0800 374 208 or send an email to: customercare@ salisbury.nhs.uk You are entitled
More informationCholecystectomy (removal of the gallbladder) Patient Information
Cholecystectomy (removal of the gallbladder) Patient Information Author ID: MP Leaflet Number: Surg 060 Name of Leaflet: Cholecystectomy (removal of the gallbladder) Version: 1 Date Produced: October 2017
More informationGallstones and Cholecystectomy Information Sheet
Gallstones and Cholecystectomy Information Sheet Gallstones & Cholecystectomy This information sheet desrcibes what they are, the treatment options, and what to expect following a operation. The following
More informationStudy of post cholecystectomy biliary leakage and its management
Original Research Article Study of post cholecystectomy biliary leakage and its management P. Krishna Kishore 1*, B. Manju Sruthi 2, G. Obulesu 3 1 Assistant Professor, Departmentment of General Surgery,
More informationGreater Manchester EUR Policy Statement Title/Topic: Labiaplasty Date: November 2014 Last Reviewed: November 2015 Reference: GM027
Greater Manchester EUR Policy Statement Title/Topic: Labiaplasty Date: November 2014 Last Reviewed: November 2015 Reference: GM027 VERSION CONTROL Version Date Details Page number 0.1 12/05/2014 First
More information6 General surgery, urology and vascular
6 General surgery, urology and vascular 6.1 Bariatric surgery in adults Bariatric surgery in adults became the commissioning responsibility of CCGs in April 2017. A Kent and Medway wide policy on access
More informationGuideline scope Diverticular disease: diagnosis and management
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Guideline scope Diverticular disease: diagnosis and management The Department of Health in England has asked NICE to develop a clinical guideline on diverticular
More informationMike Jones. Alcohol Programme Manager GM Public Health Network NHS Greater Manchester
Mike Jones Alcohol Programme Manager GM Public Health Network NHS Greater Manchester Sub-Regional Framework The seven commissions, part of the Association of Greater Manchester Authorities North West Alcohol
More informationInformation for Consent Cholecystectomy (Laparoscopic/Open) 膽囊切除術 ( 腹腔鏡 / 開放性 )
Version 1.0 Page 1 of 3 Information for Consent Cholecystectomy (Laparoscopic/Open) 膽囊切除術 ( 腹腔鏡 / 開放性 ) Introduction Gallbladder is a sac connected to the biliary tree. It serves the function of concentration
More informationCommissioning Policy. Hernia Repair in Adults. Criteria Based Access. Date Adopted: 22 nd December 2017 Version:
Commissioning Policy Hernia Repair in Adults Criteria Based Access Date Adopted: 22 nd December 2017 Version: 1819.2.00 Title of document: Authors job title(s): Document Control Hernia Repair in Adults
More informationManagement of Gallbladder Disease. Cory Buschmann, MD PGY-5 11/28/2017
Management of Gallbladder Disease Cory Buschmann, MD PGY-5 11/28/2017 Financial disclosures None Content Scope of gallbladder diseases Evaluation H&P Labs Imaging Cholecystectomy vs cholecystostomy Ancillary
More informationNATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedure overview of single-incision cholecystectomy Gallstones form in the gallbladder and can cause
More informationClinical Commissioning Policy Proposition: Pasireotide: An injectable medical therapy for the treatment of Cushing's disease
Clinical Commissioning Policy Proposition: Pasireotide: An injectable medical therapy for the treatment of Cushing's disease Information Reader Box (IRB) to be inserted on inside front cover for documents
More informationSpecialised Services Policy Position PP104
Specialised Services Policy Position PP104 Personalised External Aortic Root Support (PEARS) for surgical management of enlarged aortic root (adults) March 2019 Version 1.0 Document information Document
More informationPRIMARY CARE CO-COMMISSIONING COMMITTEE 8 SEPTEMBER 2015
Part 1 Part 2 PRIMARY CARE CO-COMMISSIONING COMMITTEE 8 SEPTEMBER 2015 Title of Report Trafford Palliative care Quality Premium Scheme 2015/16 Purpose of the Report The purpose of the report is to detail
More informationLAPAROSCOPIC GALLBLADDER SURGERY
LAPAROSCOPIC GALLBLADDER SURGERY Treating Gallbladder Problems with Laparoscopy A Common Problem If you ve had an attack of painful gallbladder symptoms, you re not alone. Gallbladder disease is very common.
More informationSpecialised Services Commissioning Policy: CP34 Circumcision for children
Specialised Services Commissioning Policy: CP34 Circumcision for children March 2019 Version 3.0 Document information Document purpose Document name Author Policy Circumcision for Children Welsh Health
More informationPRIMARY CARE CO-COMMISSIONING COMMITTEE 18 March 2016
Part 1 Part 2 PRIMARY CARE CO-COMMISSIONING COMMITTEE 18 March 2016 Title of Report Supporting deaf patients to access primary care services Purpose of the Report The report is to provide the co-commissioning
More informationCommissioning Policy: Coventry and Rugby CCG (CRCCG)
Introduction The rationale and scope of this policy is contained within the overarching LPP policy, which sets out CRCCG approach to Low Priority Procedures. This document refers specifically to Tonsillectomy/Adenotonsillectomy
More informationGallstones. Classification
Gallstones Nariman Karanjia Tahir Ali Abstract Gallstones are extremely common in the UK and have a major effect on healthcare resources. Presentation depends on whether the stones occlude the cystic duct
More informationThe Manchester Cancer Jaundice Pathway. Derek A. O Reilly Manchester Cancer HPB Pathway Director
The Manchester Cancer Jaundice Pathway Derek A. O Reilly Manchester Cancer HPB Pathway Director Introduction Pancreatic cancer has the lowest 5 year survival of any cancer in Europe (see appendix 1). Most
More informationNICE guidelines. Flu vaccination: increasing uptake in clinical risk groups and health and social care workers
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE NICE guidelines Equality impact assessment Flu vaccination: increasing uptake in clinical risk groups and health and social care workers The impact on
More informationGreater Manchester EUR Policy Statement on: Surgical drainage of the middle ear (with or without the insertion of grommets) GM Ref: GM015 Version:
Greater Manchester EUR Policy Statement on: Surgical drainage of the middle ear (with or without the insertion of grommets) GM Ref: GM015 Version: 1.1 (May 2017) Commissioning Statement Surgical drainage
More informationSex-related differences in predicting choledocholithiasis using current American Society of Gastrointestinal Endoscopy risk criteria
ORIGINAL ARTICLE Annals of Gastroenterology (2018) 31, 1-6 Sex-related differences in predicting choledocholithiasis using current American Society of Gastrointestinal Endoscopy risk criteria Ankit Chhoda
More informationERCP and EUS: What s New and What Should We Do?
ERCP and EUS: What s New and What Should We Do? Rajesh N. Keswani, MD Associate Professor of Medicine Division of Gastroenterology Northwestern University Feinberg School of Medicine EUS/ERCP in 2015 THE
More informationCholelithiasis & cholecystitis
1 Cholelithiasis & cholecystitis Dr. Muhammad Shamim FCPS (Pak), FACS (USA), FICS (USA) Assistant Professor, Dept. of Surgery College of Medicine, Prince Sattam bin Abdulaziz University Email: surgeon.shamim@gmail.com
More informationQ. As noted in the NICE Quality Standard for ADHD ( can you please provide information on:
Q. As noted in the NICE Quality Standard for ADHD (https://www.nice.org.uk/guidance/qs39), can you please provide information on: 1. What proportion of children and young people with symptoms of ADHD have
More informationGOVERNING BOARD. Assisted Conception (IVF): Review of access criteria. Date of Meeting 21 January 2015 Agenda Item No 13. Title
GOVERNING BOARD Date of Meeting 21 January 2015 Agenda Item No 13 Title Assisted Conception (IVF): Review of access criteria Purpose of Paper The SHIP (Southampton, Hampshire, Isle of Wight and Portsmouth)
More informationIn this edition we will take a look at Cholelithiasis diagnoses and illustrate the increased specificity under the ICD-10-CM nomenclature.
On October 1, 2015, the ICD-9-CM code set that is used to report medical diagnoses in the United States will be replaced with the ICD-10-CM code set. The new code set provides more than 68,000 codes, compared
More informationClinical Commissioning Policy Statement: Co-careldopa Intestinal Gel (Duodopa) December Reference : NHSCB/D4/c/3
Clinical Commissioning Policy Statement: Co-careldopa Intestinal Gel (Duodopa) December 2012 Reference : NHSCB/D4/c/3 NHS Commissioning Board Clinical Commissioning Policy Statement: Co-careldopa Intestinal
More informationInserting a percutaneous biliary drain and biliary stent (a tube to drain bile)
Patient information - Radiology Unit Tel 0118 322 7991 Inserting a percutaneous biliary drain and biliary stent (a tube to drain bile) Introduction This leaflet tells you about the procedures known as
More informationClinical Commissioning Policy Proposition: Rituximab for cytopaenia complicating primary immunodeficiency
Clinical Commissioning Policy Proposition: Rituximab for cytopaenia complicating primary immunodeficiency Reference: NHS England F06X02/01 Information Reader Box (IRB) to be inserted on inside front cover
More informationGreater Manchester EUR Policy Statement. Title/Topic: Correction of Eyelid Ptosis Reference: GM047 Date: December 2014 Last Reviewed: January 2016
Greater Manchester EUR Policy Statement Title/Topic: Correction of Eyelid Ptosis Reference: GM047 Date: December 2014 Last Reviewed: January 2016 VERSION CONTROL Version Date Details Page number 0.1 24/04/2014
More informationSpecialised Services Policy:
Specialised Services Policy: CP35 Cochlear Implants Document Author: Specialised Planner for Women & Children s Services Executive Lead: Director of Planning Approved by: Executive Board Issue Date: 05
More informationSpecialised Services Policy: CP24 Home Administered Parenteral Nutrition (HPN)
Specialised Services Policy: CP24 Home Administered Parenteral Nutrition (HPN) Document Author: Specialist Services Planning Manager for Neurosciences and Complex Conditions Executive Lead: Director of
More informationCommissioning Policy Individual Funding Request
Commissioning Policy Individual Funding Request Referrals to Secondary Care Pain Services for Assessment and Treatment Criteria Based Access Policy Date Adopted: Version: Development Individual Funding
More informationComplementary and Alternative Therapies Policy
Complementary and Alternative Therapies Policy 1 Version Control Version 2.0 Ratified by NHS Warwickshire North CCG Governing Body Date ratified 12 th January 2017 Name of originator/author Arden Clinical
More informationERCP / PTC Surgical Laparoscopic vs open Timing and order of approach
Choledocholithiasis Which Approach and When? Lygia Stewart, MD University of California, San Francisco 2010 Naffziger Post-Graduate Course Clinical Manifestations of Choledocholithiasis Asymptomatic (no
More informationThe campaign on laboratory: focus on Gallstone Disease and ERCP
The campaign on laboratory: focus on Gallstone Disease and ERCP Mauro Giuliani, MD, Specialist in Visceral Surgery, Vice Head Physician, Surgical Ward, Ospedale Regionale di Locarno Alberto Fasoli, MD,
More informationGeneral Surgery Curriculum Royal Australasian College of Surgeons, General Surgeons Australia & New Zealand Association of General Surgeons
General Surgery Curriculum Royal Australasian College of Surgeons, General Surgeons Australia & New Zealand Association of General Surgeons MODULE TITLE: UPPER GI & HPB - HEPATIC, PANCREATIC & BILIARY
More informationEarly management of complicated gallstones and acute pancreatitis
Early management of complicated gallstones and acute pancreatitis A/Prof Richard Cade George Kalogeropoulos ( Fellow) HPB/Upper GI Unit Eastern Health, Melbourne biliary colic/acute cholecystitis common
More informationClinical Commissioning Policy Proposition:
Clinical Commissioning Policy Proposition: Chemosaturation for liver metastases from ocular melanomas Reference: NHS England A02X05/01 Information Reader Box (IRB) to be inserted on inside front cover
More informationSAGES GUIDELINES FOR THE CLINICAL APPLICATION OF LAPAROSCOPIC BILIARY TRACT SURGERY
Practice/Clinical Guidelines published on: 01/2010 by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) SAGES GUIDELINES FOR THE CLINICAL APPLICATION OF LAPAROSCOPIC BILIARY TRACT
More informationManagement of Gallstone Pancreatitis: Effects of Deviation from Clinical Guidelines
Management of Gallstone Pancreatitis: Effects of Deviation from Clinical Guidelines Kevin Sargen, Andrew N Kingsnorth Department of Surgery, Plymouth Postgraduate Medical School, Derriford Hospital. Plymouth.
More informationA Guide for Patients Living with a Biliary Metal Stent
A Guide for Patients Living with a Biliary Metal Stent What is a biliary metal stent? A biliary metal stent (also known as a bile duct stent ) is a flexible metallic tube specially designed to hold your
More informationClinical Commissioning Group (CCG) Governing Body 2015/2016
Clinical Commissioning Group (CCG) Governing Body 2015/2016 Date of Meeting: 20 November 2015 Agenda Item: 8b Subject: Greater Manchester Effective Use of Resources Policies Reporting Officer: Dr C Duffy
More information28 th September Author Jeremy Gilbert Bariatric Nurse Specialist
POLICY FOR SELF ADMINISTRATION OF CONTINUOUS POSITIVE AIRWAY PRESSURE BY COMPETENT PATIENTS COMING IN FOR METABOLIC AND OBESITY SURGERY (BARIATRIC SURGERY) TO PENDENNIS WARD 28 th September 2014 Author
More informationItem Number: 6 NHS VALE OF YORK CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING. Meeting Date: 7 November Report Author: Report Sponsor:
Item Number: 6 NHS VALE OF YORK CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING Meeting Date: 7 November 2013 Report Sponsor: Dr Emma Broughton Clinical Lead for Primary Care Programme Report Author:
More informationLaparoscopic cholecystectomyy
Laparoscopic cholecystectomyy What is the gall bladder? The gallbladder is a small pear sized organ that stores bile. Bile is necessary for the digestion of fatty food. The bile duct is a tube that carries
More informationGreater Manchester EUR Policy Statement on: Radiofrequency Denervation for Back Pain GM Ref: GM004 Version: 2.1 (6 June 2018)
Greater Manchester EUR Policy Statement on: Radiofrequency Denervation for Back Pain GM Ref: GM004 Version: 2.1 (6 June 2018) Commissioning Statement Radiofrequency Denervation for Back Pain Policy Exclusions
More informationInsulin Pumps and Glucose Monitors in Adults, Children and Young People Policy
Insulin Pumps and Glucose Monitors in Adults, Children and Young People Policy Version: 2017-20 Ratified by: NHS Leeds West CCG Assurance Committee on; 16 November 2016 NHS Leeds North CCG Governance on
More informationGeneral Surgery Curriculum Royal Australasian College of Surgeons, General Surgeons Australia & New Zealand Association of General Surgeons
General Surgery Curriculum Royal Australasian College of Surgeons, General Surgeons Australia & New Zealand Association of General Surgeons MODULE TITLE: UPPER GI & HPB - HEPATIC, PANCREATIC & BILIARY
More informationPre-operative prediction of difficult laparoscopic cholecystectomy
International Surgery Journal http://www.ijsurgery.com pissn 2349-3305 eissn 2349-2902 Research Article DOI: http://dx.doi.org/10.18203/2349-2902.isj20151083 Pre-operative prediction of difficult laparoscopic
More informationYou said we did. Our Healthier South East London. Dedicated engagement events
Our Healthier South East London You said we did This report summarises the deliberative events carried out in June and other engagement activities we have undertaken so far in developing the South East
More informationExtracorporeal Shockwave Therapy (ESWT) and Radial Pulse Therapy (RPT) August 2016
Commissioning Policy Extracorporeal Shockwave Therapy (ESWT) and Radial Pulse Therapy (RPT) August 2016 This policy applies to patients for whom the following Clinical Commissioning Groups are responsible:
More informationCosting report: Lipid modification Implementing the NICE guideline on lipid modification (CG181)
Putting NICE guidance into practice Costing report: Lipid modification Implementing the NICE guideline on lipid modification (CG181) Published: July 2014 This costing report accompanies Lipid modification:
More informationSpecialised Services Policy: CP23 Vagal Nerve Stimulation
Specialised Services Policy: CP23 Vagal Nerve Stimulation Document Author: Specialist Services Planning Manager for Neurosciences and Complex Conditions Executive Lead: Director of Planning and Performance
More information