Prospective Randomized Trial Comparing Endoscopic Sphincterotomy Followed by
Surgery with Surgery Alone in Good Risk Patients with Choledocholithiasis

Kapoor, Rakesh; Kaushik, Sushmita; Saraswat, Vivek A.; Choudhuri, G; Sikora, S. S.; Saxena, Rahul; Vk, Kapoor

doi:10.1155/1996/64373

Cited by 20 publications

(11 citation statements)

References 16 publications

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“…In the pre-laparoscopic era routine ERCP prior to open surgery was found to be broadly comparable to a single stage approach of open cholecystectomy and bile duct exploration 216 – 219. However, for the reasons discussed in section 9.0, laparoscopic cholecystectomy (LC) has replaced open cholecystectomy as the reference standard for treatment of gallbladder stones.…”

Section: 0 Management Of Cbds In Specific Clinical Settingsmentioning

confidence: 99%

Guidelines on the management of common bile duct stones (CBDS)

Williams¹,

Green²,

Beckingham³

et al. 2008

Gut

502

376

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The last 30 years have seen major developments in the management of gallstone-related disease, which in the United States alone costs over 6 billion dollars per annum to treat. Endoscopic retrograde cholangiopancreatography (ERCP) has become a widely available and routine procedure, whilst open cholecystectomy has largely been replaced by a laparoscopic approach, which may or may not include laparoscopic exploration of the common bile duct (LCBDE). In addition, new imaging techniques such as magnetic resonance cholangiography (MR) and endoscopic ultrasound (EUS) offer the opportunity to accurately visualise the biliary system without instrumentation of the ducts. As a consequence clinicians are now faced with a number of potentially valid options for managing patients with suspected CBDS. It is with this in mind that the following guidelines have been written.

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Section: 0 Management Of Cbds In Specific Clinical Settingsmentioning

confidence: 99%

Guidelines on the management of common bile duct stones (CBDS)

Williams¹,

Green²,

Beckingham³

et al. 2008

Gut

502

376

View full text Add to dashboard Cite

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“…Multiple randomized controlled trials have demonstrated similar efficacy of ERCP and CBDE for the management of choledocholithiasis (CDL) in conjunction with laparoscopic cholecystectomy (LC) [4,10,16,19,20]. Some of these trials noted a shorter in-hospital length of stay (LOS) for CBDE compared to ERCP, but no difference in cost has been found based on these studies [4,16,20].…”

mentioning

confidence: 99%

National analysis of in-hospital resource utilization in choledocholithiasis management using propensity scores

2005

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“…Two recent randomized controlled trials investigating new ERCP cannulation techniques 17, 18 combined with eight randomized controlled trials from the 1990s 6, 7, 19-24 provided the summary estimate of 94% for ERCP stone removal.…”

Section: Methodsmentioning

confidence: 99%

Cost-Effective Treatment of Patients with Symptomatic Cholelithiasis and Possible Common Bile Duct Stones

Brown

Rogers

Cello

et al. 2011

Journal of the American College of Surgeons

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Background Clinicians must choose a treatment strategy for patients with symptomatic cholelithiasis without knowing whether common bile duct (CBD) stones are present. The purpose of this study was to determine the most cost-effective treatment strategy for patients with symptomatic cholelithiasis and possible CBD stones. Study Design Our decision model included five treatment strategies: (1) laparoscopic cholecystectomy (LC) alone followed by expectant management, (2) preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by LC, (3) LC with intraoperative cholangiography (IOC) ± common bile duct exploration (CBDE), (4) LC followed by postoperative ERCP, and (5) LC with IOC ± postoperative ERCP. The rates of successful completion of diagnostic testing and therapeutic intervention, test characteristics (sensitivity and specificity), morbidity, and mortality for all procedures are from current literature. Hospitalization costs and lengths of stay are from the 2006 National CMS data. The probability of CBD stones was varied from 0% to 100% and the most cost-effective strategy was determined at each probability. Results Across the CBD stone probability range of 4% to 100%, LC with IOC ± ERCP was the most cost-effective. If the probability was 0%, LC alone was the most cost-effective. Our model was sensitive to one health input: specificity of IOC, and three costs: cost of hospitalization for LC with CBDE, cost of hospitalization for LC without CBDE, and cost of LC with IOC. Conclusions The most cost-effective treatment strategy for the majority of patients with symptomatic cholelithiasis is LC with routine IOC. If stones are detected, CBDE should be forgone and the patient referred for ERCP.

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Prospective Randomized Trial Comparing Endoscopic Sphincterotomy Followed by Surgery with Surgery Alone in Good Risk Patients with Choledocholithiasis

Abstract: Background." Role of endoscopic sphincterotomy (ES)

Cited by 20 publications

References 16 publications

Guidelines on the management of common bile duct stones (CBDS)

Guidelines on the management of common bile duct stones (CBDS)

National analysis of in-hospital resource utilization in choledocholithiasis management using propensity scores

Cost-Effective Treatment of Patients with Symptomatic Cholelithiasis and Possible Common Bile Duct Stones

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