Endoscopic sphincterotomy with or without cholecystectomy for choledocholithiasis in high‐risk surgical patients: a decision analysis

Abstract

SUMMARY BackgroundLaparoscopic cholecystectomy (LC) is recommended for patients with choledocholithiasis after ERCP with sphincterotomy (ES) and stone extraction.

Management of Preoperatively Suspected Choledocholithiasis: A Decision Analysis

“…Therefore, patients with symptomatic CBD stones and who are high operative risk [American Society of Anesthesiologists (ASA) IV, V or elderly patient over 70] may be considered for ERCP/ES without cholecystectomy. 18 Laparoscopic cholecystectomy and IOC with LCBDE, when choledocholithiasis is found without preoperative ERCP, is recommended for surgeons with the skill and facilities to do LCBDE. If surgeons are not skilled in LCBDE or practice in hospitals which cannot support LCBDE, then a Fitzgibbons tube is a good alternative.…”

“…1,3,[10][11][12]14,[16][17][18]20,21,33 The positive IOC incidence varies and is approximately 22% and a reported incidence of negative ERCP of 55%, 80%, 84%, and 93% in patients presenting with jaundice, pancreatitis, colic, and cholecystitis, respectively, and others reporting incidence of 50-72%. 4,[7][8][9]20,21,24,30 Laparoscopic cholecystectomy with IOC carries a morbidity of more than 6% and a mortality of 0.1% (Table 2).…”

“…The possible outcomes and the probabilities of these outcomes were obtained from the literature. 1,[3][4][5][6][7][8][11][12][13][14][15][16][17][18][19][20][21][22][23]25,26,[28][29][30][31][32] Sensitivity Analysis As there are ranges of probabilities of postoperative events occurring, sensitivity analysis is the process of varying the chances of different outcomes occurring in order to determine the effects of different probabilities on the decision. For this decision analysis, we varied the incidence of common bile duct stones.…”

“…1,3,4,7,[11][12][13] There have been many studies reporting success rates, morbidity, mortality, length of stay, and cost for each of these management options. 1,[3][4][5]7,8,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] The purpose of this study was to use decision analysis to determine the optimal management of patients harboring suspected common bile duct stones.…”

Endoscopic Sphincterotomy With or Without Cholecystectomy for Choledocholithiasis in High Risk Surgical Patients: A Decision Analysis

“…It should be noted that the biliary complication rate in the wait-and-see group (47%) was significantly higher when compared with other similar trials. Several other trials [28][29][30] have also suggested ES LC as treatment of choice in younger low-risk patients with choledocholithiasis.…”