Modern approach to cholecysto-choledocholithiasis

Abstract

Gallstones and common bile duct calculi are found to be associated in 8%-20% of patients, leading to possible life-threatening complications, such as acute biliary pancreatitis, jaundice and cholangitis. The gold standard of care for gallbladder calculi and isolated common bile duct stones is represented by laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography, respectively, while a debate still exists regarding how to treat the two diseases at the same time. Many therapeutic options are also available when the two conditions are associated, including many different types of treatment, which local professionals often administer. The need to limit maximum discomfort and risks for the patients, combined with the economic pressure of reducing costs and utilizing resources, favors single-step procedures. However, a multitude of data fail to strongly demonstrate the superiority of any technique (including a two or multi-step approach), while rigorous clinical trials that include so many different types of treatment are still lacking, and it is most likely unrealistic to conduct them in the future. Therefore, the choice of the best management is often led by the local presence of professional expertise and resources, rather than by a real superiority of one strategy over another.

Intraoperative ERCP for management of cholecystocholedocholithiasis

“…Moreover, because the expertise in surgical bile duct exploration is diminishing significantly, many surgeons remain fearful of conducting LCBDE [26]; therefore, the treatment strategy is often led by the local presence of professional expertise and resources, rather than by a real superiority of one strategy over another [27]. The preferred option for Open CBD exploration (n = 2)…”

Factores predictores perioperatorios de complicaciones de la colecistectomía por laparoscopia

“…De acuerdo con los datos estadísticos de incidencia de coledocoliatiasis en la población con colecistitis y teniendo en cuenta los predictores de coledocolitiasis 23 , se indicó la colangiopancreatografía retrógrada endoscópica en 11,6 % de los pacientes 24 . Asimismo, debido a que el resultado podría afectarse estadísticamente con el modelo de diagnóstico de coledocolitiasis, al igual que con la colangiopancreatografía retró-grada endoscópica, y debido a que clínicamente son variables complementarias, se decidió excluir este procedimiento como punto predictor de una complicación mayor y se analizó junto con la presencia de un diagnóstico de coledocolitiasis previo a la cirugía.…”

Acute Pancreatitis

“…But a great number of studies failed to strongly demonstrate the superiority of any technique, and it is unlikely that in the future some rigorous clinical trials will be conducted to compare so many different types of therapeutic options. Therefore, the choice of the best management is often driven by the local presence of professional expertise and resources, rather than by a real superiority of one strategy over another [42]. Nowadays, endoscopic procedures are among the preferred strategies for treatment of bile duct stones.…”